Healthcare Provider Details

I. General information

NPI: 1104833995
Provider Name (Legal Business Name): LIFE ENHANCEMENT CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 CALLE PULIDO
SANTA FE NM
87505-5242
US

IV. Provider business mailing address

2274 CALLE PULIDO
SANTA FE NM
87505-5242
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-4815
  • Fax:
Mailing address:
  • Phone: 505-474-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1473
License Number StateNM

VIII. Authorized Official

Name: DR. WENDY B FELDMAN-BOHOSKEY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 505-474-4815