Healthcare Provider Details

I. General information

NPI: 1952318867
Provider Name (Legal Business Name): BEAR CANYON HEALTH CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 JUAN TABO NE STE B
ALBUQ NM
87111-2627
US

IV. Provider business mailing address

4800 JUAN TABO BLVD NE STE B
ALBUQUERQUE NM
87111-2627
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1795
  • Fax: 505-888-1904
Mailing address:
  • Phone: 505-888-1795
  • Fax: 505-888-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1348
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1616
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA GRACE OSTON
Title or Position: CORP. SEC. / TRES.
Credential:
Phone: 505-888-1795