Kenneth P. Soulsby, D.C.
Individual provider Active NPI Chiropractor · Deming, NM
NPI 1417048679 · NPPES record last updated Oct 20, 2010
Key facts
- NPI
- 1417048679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 839 (NM)
- Practice address
- 909 South Gold Ave
Deming, NM 88030-4754 - Phone
- (575) 546-7331
- Fax
- (575) 546-5380
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 839 | NM | MD | Acupuncturist |
| 3800 | AZ | MD | Veterinarian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 839 | NM | Yes |
| Chiropractor | 111N00000X | 3800 | AZ |
Addresses
Primary practice location
909 South Gold Ave
Deming, NM 88030-4754
Mailing address
909 South Gold Ave
Deming, NM 88030-4754
Phone (575) 546-7331
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00132383 | Other | NM | RAILROAD MEDICARE PIN |
Other providers in Deming, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.