Healthcare Provider Details

I. General information

NPI: 1720551658
Provider Name (Legal Business Name): INLINE CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 W HWY 550 STE C
BERNALILLO NM
87004-6057
US

IV. Provider business mailing address

965 W HWY 550 STE C
BERNALILLO NM
87004-6057
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-3322
  • Fax:
Mailing address:
  • Phone: 505-860-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TRACY MARQUEZ
Title or Position: DOCTOR
Credential:
Phone: 505-860-1418