Healthcare Provider Details

I. General information

NPI: 1659340644
Provider Name (Legal Business Name): LINDA R HITE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 E AZTEC AVE SUITE #7
GALLUP NM
87301-4946
US

IV. Provider business mailing address

PO BOX 3515
GALLUP NM
87305-3515
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-3979
  • Fax: 505-722-6040
Mailing address:
  • Phone: 505-862-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1613
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: