Healthcare Provider Details

I. General information

NPI: 1558587345
Provider Name (Legal Business Name): LA MESA CHIROPRACTIC AND REHABILITATION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 HUTTON AVE
FARMINGTON NM
87402-4564
US

IV. Provider business mailing address

2904 HUTTON AVE
FARMINGTON NM
87402-4564
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4845
  • Fax: 505-327-6274
Mailing address:
  • Phone: 505-327-4845
  • Fax: 505-327-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY S ROWSE
Title or Position: VP
Credential: D.C.
Phone: 505-327-4845