Healthcare Provider Details

I. General information

NPI: 1609312172
Provider Name (Legal Business Name): BACK TO HEALTH WELLNESS CENTER. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST STE 12
SANTA FE NM
87505-2113
US

IV. Provider business mailing address

1651 GALISTEO ST STE 12
SANTA FE NM
87505-2113
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-8999
  • Fax: 505-982-9770
Mailing address:
  • Phone: 505-467-8999
  • Fax: 505-982-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1087
License Number StateNM

VIII. Authorized Official

Name: CHAZ SCHATZLE
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C., A.P.C.
Phone: 505-467-8999