Healthcare Provider Details

I. General information

NPI: 1487927489
Provider Name (Legal Business Name): HEALTH QUEST WELLNESS BOSQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-8931
US

IV. Provider business mailing address

155 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-8931
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-2273
  • Fax: 505-869-9958
Mailing address:
  • Phone: 505-869-2273
  • Fax: 505-869-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1483
License Number StateNM

VIII. Authorized Official

Name: DR. RYAN P WOLFF
Title or Position: PRIMARY/MANAGING DOCTOR
Credential: D.C.
Phone: 505-869-2273