MEDICARE: BEAR CANYON HEALTH CIRCLE

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	111N00000X	Chiropractor	1348	NM
2	111N00000X	Chiropractor	1616	NM
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1952318867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR CANYON HEALTH CIRCLE

Provider Business Mailing Address
First Line	:	4800 JUAN TABO BLVD NE
Second Line	:	STE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2627
Country	:	US
Telephone Number	:	505-888-1795
Fax Number	:	505-888-1904

Provider Business Practice Location Address
First Line	:	4800 JUAN TABO NE
Second Line	:	STE B
City	:	ALBUQ
State	:	NM
Zip	:	87111-2627
Country	:	US
Telephone Number	:	505-888-1795
Fax Number	:	505-888-1904

Authorized Official
Title or Position	:	CORP. SEC. / TRES.
Name	:	MRS. ANGELA GRACE OSTON
Credential	:
Telephone Number	:	505-888-1795

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/10/2014

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Directions to “BEAR CANYON HEALTH CIRCLE ” Practice Location

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