Healthcare Provider Details

I. General information

NPI: 1033547302
Provider Name (Legal Business Name): HEALTH QUEST WELLNESS COTTONWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9664 EAGLE RANCH RD NW STE A-1
ALBUQUERQUE NM
87114-1578
US

IV. Provider business mailing address

PO BOX 92348
ALBUQUERQUE NM
87199-2348
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-9355
  • Fax:
Mailing address:
  • Phone: 505-890-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2070
License Number StateNM

VIII. Authorized Official

Name: DR. ALLEN R MINER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-433-4646