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General NPI Number Information
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NPI Number | 1275607426
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Entity Type | Organization
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Legal Business Name | NOB HILL HERMOSA, INCORPORATED
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 201 DARTMOUTH DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2219
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Country | US
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Telephone | 505-265-9656
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Fax | 505-265-2096
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Provider Business Mailing Address
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Address Line | 201 DARTMOUTH DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2219
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Country | US
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Telephone | 505-265-9656
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Fax | 505-265-2096
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN SCOTT GARDNER
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Credential | D.C.
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Telephone | 505-265-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 722
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License Number State | NM
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