Provider Demographics
NPI:1942532585
Name:LEGATE, STEPHEN MARK (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:LEGATE
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 1:12901 CALLE DE SANDIAS NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2922
Mailing Address - Country:US
Mailing Address - Phone:617-678-7888
Mailing Address - Fax:
Practice Address - Street 1:6751 ACADEMY RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3386
Practice Address - Country:US
Practice Address - Phone:505-414-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2078111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor