Provider Demographics
NPI:1871623272
Name:KACPER FIUTEK PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:KACPER FIUTEK PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KACPER
Authorized Official - Middle Name:
Authorized Official - Last Name:FIUTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-884-0771
Mailing Address - Street 1:3500 COMANCHE RD NE STE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4546
Mailing Address - Country:US
Mailing Address - Phone:505-884-0771
Mailing Address - Fax:505-884-0776
Practice Address - Street 1:3500 COMANCHE RD NE
Practice Address - Street 2:SUITE I
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-884-0771
Practice Address - Fax:505-884-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32413800OtherATTENDING PIN