Provider Demographics
NPI:1356453328
Name:MILLENNIUM CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MILLENNIUM CHIROPRACTIC PC
Other - Org Name:MILLENNIUM HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-521-0793
Mailing Address - Street 1:3850 E LOHMAN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-521-0793
Mailing Address - Fax:575-532-1607
Practice Address - Street 1:3850 E LOHMAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-521-0793
Practice Address - Fax:505-532-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
800521185Medicare PIN