Provider Demographics
NPI:1437248861
Name:CALKINS, HOMER WILLIS (BS,DC)
Entity type:Individual
Prefix:DR
First Name:HOMER
Middle Name:WILLIS
Last Name:CALKINS
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:DR
Other - First Name:WILLIS
Other - Middle Name:
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, DC
Mailing Address - Street 1:802 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6420
Mailing Address - Country:US
Mailing Address - Phone:575-437-0843
Mailing Address - Fax:575-437-6070
Practice Address - Street 1:802 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6420
Practice Address - Country:US
Practice Address - Phone:575-437-0843
Practice Address - Fax:575-437-6070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1524111N00000X
TX8948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89950062Medicaid
NMP00227888Medicare PIN
NM89950062Medicaid