Provider Demographics
NPI:1902134356
Name:LEE F. PURCARO D.C. L.L.C.
Entity Type:Organization
Organization Name:LEE F. PURCARO D.C. L.L.C.
Other - Org Name:LEE F. PURCARO D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:F
Authorized Official - Last Name:PURCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-275-1090
Mailing Address - Street 1:9004 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2259
Mailing Address - Country:US
Mailing Address - Phone:505-275-1090
Mailing Address - Fax:505-275-1090
Practice Address - Street 1:9004 MENAUL BLVD NE
Practice Address - Street 2:SUITE 9
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2259
Practice Address - Country:US
Practice Address - Phone:505-275-1090
Practice Address - Fax:505-275-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU98359Medicare UPIN