Organization
PHYLLIS NADINE GONZALES
Active
Other names
Universal Chiropractic Dr. P.Nadine Gonzales, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHYLLIS NADINE GONZALES DC, BSN-RN (OWNER)
(505) 946-7677
Entity
Organization
Contact information
Practice address
219 WASHINGTON AVE, SANTA FE, NM 87501-1926
(505) 946-7677
(505) 986-1569
Mailing address
121 CAMINO ENCANTADO, SANTA FE, NM 87501-1039
(505) 946-7677
(505) 986-1569
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1318
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11NR0400X
NUCC TAXONOMY
NM
01
—
12248763
CAQH
NM
01
—
12395202
MULTIPLAN
NM
01
—
1821150756
NPI TYPE 1
—
01
—
5657319
FIRST HEALTH
NM
01
—
693017
ACN GROUP
NM
01
—
876338000
REGENCE BCBS OREGON
OR
01
—
9408737
PRIVATE HEALTHCARE SYSTEM
NM
01
—
NM00KL98
BLUE CROSS BLUE SHIELD NM
NM
Enumeration date
10/16/2014
Last updated
03/04/2015
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