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General NPI Number Information
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NPI Number | 1932408168
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST CHIROPRACTIC AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 6586 E MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87402-5122
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Country | US
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Telephone | 505-564-2225
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Fax | 505-564-2226
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Provider Business Mailing Address
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Address Line | 6586 E MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87402-5122
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Country | US
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Telephone | 505-564-2225
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Fax | 505-564-2226
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ERIC WARDEN CARPENTER
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Credential | D.C.
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Telephone | 505-564-2225
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1885
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License Number State | NM
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