MEDICARE: HOPE CHIROPRACTIC CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	1850	NM

General Provider Information

NPI Number	:	1841599396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE CHIROPRACTIC CLINIC LLC

Provider Business Mailing Address
First Line	:	1700 E AMADOR AVE
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3119
Country	:	US
Telephone Number	:	575-652-4092
Fax Number	:	575-652-4561

Provider Business Practice Location Address
First Line	:	1700 E AMADOR AVE
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3119
Country	:	US
Telephone Number	:	575-652-4092
Fax Number	:	575-652-4561

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. CHARLES IRVIN LENZ
Credential	:	D.C.
Telephone Number	:	575-652-4092

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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