Healthcare Provider Details

I. General information

NPI: 1497065825
Provider Name (Legal Business Name): JEREMY ROBILLARD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E. BENDER
HOBBS NM
88240
US

IV. Provider business mailing address

1003 E BENDER BLVD
HOBBS NM
88240-2415
US

V. Phone/Fax

Practice location:
  • Phone: 575-318-2640
  • Fax: 575-318-2641
Mailing address:
  • Phone: 575-318-2640
  • Fax: 575-318-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11584
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1882
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: