Provider Demographics
NPI:1861138620
Name:RIO RANCHO ACUPUNCTURE LLC
Entity type:Organization
Organization Name:RIO RANCHO ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:970-222-0575
Mailing Address - Street 1:10400 ACADEMY RD NE STE 210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7370
Mailing Address - Country:US
Mailing Address - Phone:505-355-1984
Mailing Address - Fax:
Practice Address - Street 1:10400 ACADEMY RD NE STE 210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7370
Practice Address - Country:US
Practice Address - Phone:505-355-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty