Provider Demographics
NPI:1194200725
Name:PARRA TORRES, RAFAEL IVAN (DC)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:IVAN
Last Name:PARRA TORRES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1128
Mailing Address - Country:US
Mailing Address - Phone:915-263-3715
Mailing Address - Fax:
Practice Address - Street 1:2151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1128
Practice Address - Country:US
Practice Address - Phone:915-263-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16201111N00000X
TX18-381246ZC0007X
NM2024-0014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant