Healthcare Provider Details

I. General information

NPI: 1164531364
Provider Name (Legal Business Name): CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N. UNION
ROSWELL NM
88201
US

IV. Provider business mailing address

811 N. UNION
ROSWELL NM
88201
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-6691
  • Fax: 575-623-6144
Mailing address:
  • Phone: 575-623-6691
  • Fax: 575-623-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1110
License Number StateNM

VIII. Authorized Official

Name: LOUISE SIGALA
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-623-6691