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General NPI Number Information
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NPI Number | 1679760649
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Entity Type | Organization
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Legal Business Name | HILLIARD CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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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 | 505-356-6982
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Fax | 505-356-3773
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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 | 505-356-6982
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Fax | 505-356-3773
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM KENT HILLIARD
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Credential | DC
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Telephone | 505-356-6982
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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 | 480
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License Number State | NM
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