Healthcare Provider Details

I. General information

NPI: 1336307164
Provider Name (Legal Business Name): HEALING ARTS CHIROPRACTIC AND NUTRITION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 GOLF COURSE RD SE SUITE C
RIO RANCHO NM
87124-1626
US

IV. Provider business mailing address

2105 GOLF COURSE RD SE SUITE C
RIO RANCHO NM
87124-1626
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-3031
  • Fax: 505-896-3242
Mailing address:
  • Phone: 505-220-3031
  • Fax: 505-896-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1532
License Number StateNM

VIII. Authorized Official

Name: DR. LATHY LYNN PHILLIPS
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 505-220-3031