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General NPI Number Information
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NPI Number | 1033547302
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Entity Type | Organization
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Legal Business Name | HEALTH QUEST WELLNESS COTTONWOOD LLC
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 9664 EAGLE RANCH RD NW STE A-1
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1578
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Country | US
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Telephone | 505-890-9355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 92348
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-2348
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Country | US
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Telephone | 505-890-9355
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLEN R MINER
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Credential | D.C.
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Telephone | 505-433-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2070
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License Number State | NM
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