Healthcare Provider Details

I. General information

NPI: 1457788317
Provider Name (Legal Business Name): HEALTH QUEST WELLNESS JOURNAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4479
US

IV. Provider business mailing address

PO BOX 95767
ALBUQUERQUE NM
87199-5767
US

V. Phone/Fax

Practice location:
  • Phone: 505-343-6120
  • Fax:
Mailing address:
  • Phone: 505-343-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1619
License Number StateNM

VIII. Authorized Official

Name: DR. ALLEN R MINER
Title or Position: PRESIDENT
Credential: DC
Phone: 505-343-6120