Provider Demographics
NPI:1104833995
Name:LIFE ENHANCEMENT CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT CHIROPRACTIC, INC.
Other - Org Name:WENDY FELDMAN-BOHOSKEY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FELDMAN-BOHOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-474-4815
Mailing Address - Street 1:2274 CALLE PULIDO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5242
Mailing Address - Country:US
Mailing Address - Phone:505-474-4815
Mailing Address - Fax:
Practice Address - Street 1:2274 CALLE PULIDO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5242
Practice Address - Country:US
Practice Address - Phone:505-474-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00KL87OtherBLUE CROSS BLUE SHIELD OF