Healthcare Provider Details

I. General information

NPI: 1922270164
Provider Name (Legal Business Name): MARILYN JOYCE COADY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 N LOVINGTON HWY
HOBBS NM
88240-1011
US

IV. Provider business mailing address

4530 N LOVINGTON HWY
HOBBS NM
88240-1011
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-9004
  • Fax: 575-392-1370
Mailing address:
  • Phone: 575-392-9004
  • Fax: 575-392-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number753
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: