Provider Demographics
NPI:1194225557
Name:ABERCROMBIE WELLNESS CLINIC
Entity Type:Organization
Organization Name:ABERCROMBIE WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ABERCROMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-885-5808
Mailing Address - Street 1:1234 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4017
Mailing Address - Country:US
Mailing Address - Phone:575-885-5808
Mailing Address - Fax:575-887-1011
Practice Address - Street 1:1234 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4017
Practice Address - Country:US
Practice Address - Phone:575-885-5808
Practice Address - Fax:575-887-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty