Healthcare Provider Details

I. General information

NPI: 1386955292
Provider Name (Legal Business Name): CHIROPRACTIC NATURAL HIGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARBARA LOOP SE SUITE C1
RIO RANCHO NM
87124-1068
US

IV. Provider business mailing address

4111 BARBARA LOOP SE SUITE C1
RIO RANCHO NM
87124-1068
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3345
  • Fax: 505-891-3340
Mailing address:
  • Phone: 505-891-3345
  • Fax: 505-891-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1053
License Number StateNM

VIII. Authorized Official

Name: DR. WILLIAM LEE WALKER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-891-3345