Individual
BEN DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 W CORDOVA RD, SANTA FE, NM 87505-1850
(505) 984-8998
Mailing address
201 RICARDO RD, SANTA FE, NM 87501-1737
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
083440003
CO
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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