MEDICARE: MOUNTAIN STAR CHIROPRACTIC

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1417182288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN STAR CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3924 CARLISLE BLVD NE
Second Line	:	SUITE 10
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3924 CARLISLE BLVD NE
Second Line	:	SUITE 10
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4504
Country	:	US
Telephone Number	:	505-990-6954
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ART ACHULETA
Credential	:
Telephone Number	:	915-472-3434

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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