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General NPI Number Information
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NPI Number | 1366801672
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Entity Type | Organization
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Legal Business Name | HILLIARD CHIROPRACTIC GROUP INC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 112 E 4TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6305
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Country | US
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Telephone | 575-356-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 112 E 4TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6305
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Country | US
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Telephone | 575-356-6982
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | GREGORY BOBO
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Credential | D.C.
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Telephone | 770-377-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2128
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License Number State | NM
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