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General NPI Number Information
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NPI Number | 1275821233
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Entity Type | Organization
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Legal Business Name | INFINITE HEALTH CHIROPRACTIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 904 E 20TH ST SUITE A
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City | FARMINGTON
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State | NM
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Zip | 87401-4281
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Country | US
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Telephone | 505-325-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 904 E 20TH ST SUITE A
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City | FARMINGTON
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State | NM
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Zip | 87401-4281
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Country | US
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Telephone | 505-325-2010
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. JASON SCOTT DOOLIN
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Credential | D.C.
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Telephone | 505-325-2010
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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 | 1891
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License Number State | NM
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