Healthcare Provider Details

I. General information

NPI: 1396816971
Provider Name (Legal Business Name): IPC, INC. DBA ISLAND PARK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W COLLEGE AVE STE 10
SILVER CITY NM
88061-5002
US

IV. Provider business mailing address

417 XYZ RANCH RD
ARENAS VALLEY NM
88022-9755
US

V. Phone/Fax

Practice location:
  • Phone: 575-493-8009
  • Fax:
Mailing address:
  • Phone: 541-554-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY PAUL WALTON
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 541-554-9994