Healthcare Provider Details

I. General information

NPI: 1548650245
Provider Name (Legal Business Name): APOLLO CHIROPRACTIC HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 TAYLOR RANCH RD NW STE C8
ALBUQUERQUE NM
87120-2962
US

IV. Provider business mailing address

6911 TAYLOR RANCH RD NW STE C8
ALBUQUERQUE NM
87120-2962
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-3311
  • Fax: 505-792-3312
Mailing address:
  • Phone: 505-792-3311
  • Fax: 505-792-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2100
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2100
License Number StateNM

VIII. Authorized Official

Name: DR. ERIC D. DAHL
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 505-792-3311