=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790878825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HANDS WELLNES CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1808 E AZTEC AVE STE 7
-----------------------------------------------------
City | GALLUP
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87301-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-722-3979
-----------------------------------------------------
Fax | 505-722-6040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3515
-----------------------------------------------------
City | GALLUP
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87305-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-722-3979
-----------------------------------------------------
Fax | 505-722-6040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | DR. LINDA R. HITE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 505-722-3979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1613
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------