Provider Demographics
NPI:1124084348
Name:WASSON, DEAN C (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:C
Last Name:WASSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1511 GOLF COURSE RD SE
Mailing Address - Street 2:STE. C
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1956
Mailing Address - Country:US
Mailing Address - Phone:505-933-8600
Mailing Address - Fax:505-933-8601
Practice Address - Street 1:1511 GOLF COURSE RD SE
Practice Address - Street 2:STE. C
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1956
Practice Address - Country:US
Practice Address - Phone:505-933-8600
Practice Address - Fax:505-933-8601
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97238Medicare UPIN