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General NPI Number Information
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NPI Number | 1811003460
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CLINIC LIMITED
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 7423 TRICIA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1797
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Country | US
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Telephone | 505-334-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 7423 TRICIA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1797
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Country | US
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Telephone | 505-860-1418
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRACY MARQUEZ
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Credential |
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Telephone | 505-334-5000
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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 | 1322
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License Number State | NM
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