Healthcare Provider Details

I. General information

NPI: 1942669460
Provider Name (Legal Business Name): AAAHH CHIROSPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE STE 24
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

717 ENCINO PL NE STE 24
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-0044
  • Fax: 505-881-7393
Mailing address:
  • Phone: 505-884-0044
  • Fax: 505-881-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRK E MANSON
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 505-884-0044