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General NPI Number Information
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NPI Number | 1720246069
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Entity Type | Organization
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Legal Business Name | ENCHANTED HILLS FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 1889 MESA GRANDE LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-0568
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Country | US
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Telephone | 505-908-1990
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Fax | 505-867-7441
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Provider Business Mailing Address
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Address Line | 1889 MESA GRANDE LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-0568
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Country | US
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Telephone | 505-908-1990
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Fax | 505-867-7441
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB GENE ROBINSON
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Credential | D.C.
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Telephone | 505-867-1122
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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 | 1650
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License Number State | NM
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