Provider Demographics
NPI:1235468265
Name:CORE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-819-7340
Mailing Address - Street 1:2009 BOTULPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1107
Mailing Address - Country:US
Mailing Address - Phone:505-819-7340
Mailing Address - Fax:
Practice Address - Street 1:207 ROSARIO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1341
Practice Address - Country:US
Practice Address - Phone:505-819-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty