=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538495098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH QUEST WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2009
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3824 MASTHEAD ST NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-343-6120
-----------------------------------------------------
Fax | 505-343-1434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3824 MASTHEAD ST NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-343-6120
-----------------------------------------------------
Fax | 505-343-1434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALLEN MINER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 505-343-6120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1574
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------