=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386955292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC NATURAL HIGH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2010
-----------------------------------------------------
Last Update Date | 05/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4111 BARBARA LOOP SE SUITE C1
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-891-3345
-----------------------------------------------------
Fax | 505-891-3340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4111 BARBARA LOOP SE SUITE C1
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-891-3345
-----------------------------------------------------
Fax | 505-891-0601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM LEE WALKER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 505-891-3345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1053
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------