Healthcare Provider Details

I. General information

NPI: 1679543540
Provider Name (Legal Business Name): THE CHIROPRACTIC CARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87110-1615
US

IV. Provider business mailing address

3100 CARLISLE BLVD NE STE B
ALBUQUERQUE NM
87110-1615
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4533
  • Fax: 505-888-0179
Mailing address:
  • Phone: 505-888-4533
  • Fax: 505-888-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNM1472
License Number StateNM

VIII. Authorized Official

Name: DR. TERENCE LEE TIMM
Title or Position: PRESIDENT
Credential: DC
Phone: 505-888-4533