MEDICARE: AAAHH CHIROSPA 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	111NI0900X	Internist Chiropractor

General Provider Information

NPI Number	:	1942669460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAAHH CHIROSPA LLC

Provider Business Mailing Address
First Line	:	717 ENCINO PL NE
Second Line	:	STE 24
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2611
Country	:	US
Telephone Number	:	505-884-0044
Fax Number	:	505-881-7393

Provider Business Practice Location Address
First Line	:	717 ENCINO PL NE
Second Line	:	STE 24
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2611
Country	:	US
Telephone Number	:	505-884-0044
Fax Number	:	505-881-7393

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. KIRK E MANSON
Credential	:	D.C.
Telephone Number	:	505-884-0044

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	04/23/2019

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Directions to “AAAHH CHIROSPA LLC ” Practice Location

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