Healthcare Provider Details

I. General information

NPI: 1184025892
Provider Name (Legal Business Name): INSIDE OUT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MAIN ST NE SUITE C
LOS LUNAS NM
87031-7409
US

IV. Provider business mailing address

1202 MAIN ST NE SUITE C
LOS LUNAS NM
87031-7409
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-9436
  • Fax:
Mailing address:
  • Phone: 505-730-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1502
License Number StateNM

VIII. Authorized Official

Name: DR. NIKI WOLFF
Title or Position: OWNER
Credential: D.C.
Phone: 505-730-9436