Healthcare Provider Details

I. General information

NPI: 1740530955
Provider Name (Legal Business Name): CHIWAWA CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W HADLEY AVE
LAS CRUCES NM
88005-1806
US

IV. Provider business mailing address

2001 E LOHMAN AVE 110-183
LAS CRUCES NM
88001-3167
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-2318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1966
License Number StateNM

VIII. Authorized Official

Name: DR. TAPIWA CHIWAWA
Title or Position: OWNER
Credential: D.C.
Phone: 575-520-2318