Healthcare Provider Details

I. General information

NPI: 1841599396
Provider Name (Legal Business Name): HOPE CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E AMADOR AVE SUITE A
LAS CRUCES NM
88001-3119
US

IV. Provider business mailing address

1700 E AMADOR AVE SUITE A
LAS CRUCES NM
88001-3119
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-4092
  • Fax: 575-652-4561
Mailing address:
  • Phone: 575-652-4092
  • Fax: 575-652-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number1850
License Number StateNM

VIII. Authorized Official

Name: DR. CHARLES IRVIN LENZ
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 575-652-4092