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NPI Code Detail

MEDICARE: HEALTH QUEST WELLNESS COTTONWOOD LLC

MEDICARE: HEALTH QUEST WELLNESS COTTONWOOD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center2070NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11730484627OTHERNMINDIVIDUAL NPI

General Provider Information

NPI Number : 1033547302
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTH QUEST WELLNESS COTTONWOOD LLC
Provider Business Mailing Address
First Line : PO BOX 92348
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87199-2348
Country : US
Telephone Number : 505-890-9355
Fax Number :
Provider Business Practice Location Address
First Line : 9664 EAGLE RANCH RD NW STE A-1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114-1578
Country : US
Telephone Number : 505-890-9355
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ALLEN R MINER
Credential : D.C.
Telephone Number : 505-433-4646
Provider Enumeration Date : 10/24/2013
Last Update Date : 09/18/2014

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Directions to “HEALTH QUEST WELLNESS COTTONWOOD LLC ” Practice Location

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