Provider Demographics
NPI:1053646463
Name:NOSEFF FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NOSEFF FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRIED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NOSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-492-1502
Mailing Address - Street 1:2410 N FOWLER ST
Mailing Address - Street 2:STE. A
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2312
Mailing Address - Country:US
Mailing Address - Phone:575-492-1502
Mailing Address - Fax:
Practice Address - Street 1:2410 N FOWLER ST
Practice Address - Street 2:STE. A
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2312
Practice Address - Country:US
Practice Address - Phone:575-492-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-03
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty