Healthcare Provider Details

I. General information

NPI: 1053646463
Provider Name (Legal Business Name): NOSEFF FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 N FOWLER ST STE. A
HOBBS NM
88240-2312
US

IV. Provider business mailing address

2410 N FOWLER ST STE. A
HOBBS NM
88240-2312
US

V. Phone/Fax

Practice location:
  • Phone: 575-492-1502
  • Fax:
Mailing address:
  • Phone: 575-492-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1755
License Number StateNM

VIII. Authorized Official

Name: DR. JERRIED LEE NOSEFF
Title or Position: OWNER
Credential: D.C.
Phone: 575-492-1502