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General NPI Number Information
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NPI Number | 1427336098
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Entity Type | Organization
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Legal Business Name | ROSWELL FAMILY CHIROPRACTIC AND WELLNESS PA
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 100 E LINDA VISTA BLVD
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City | ROSWELL
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State | NM
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Zip | 88201-6654
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Country | US
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Telephone | 575-623-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E LINDA VISTA BLVD
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City | ROSWELL
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State | NM
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Zip | 88201-6654
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Country | US
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Telephone | 575-623-2900
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. RICHARD LEE GLENN
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Credential | D.C.
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Telephone | 575-623-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1909
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License Number State | NM
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