Healthcare Provider Details

I. General information

NPI: 1144331315
Provider Name (Legal Business Name): HEALTHPLEX CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD SUITE C2A
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

8201 GOLF COURSE RD SUITE C2A
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-3311
  • Fax: 505-792-3314
Mailing address:
  • Phone: 505-792-3311
  • Fax: 505-792-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1572
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1532
License Number StateNM

VIII. Authorized Official

Name: DR. KATHY LYNN PHILLIPS
Title or Position: CHIROPRACTOR,OWNER
Credential: DC
Phone: 505-792-3311