Provider Demographics
NPI:1417182288
Name:MOUNTAIN STAR CHIROPRACTIC
Entity Type:Organization
Organization Name:MOUNTAIN STAR CHIROPRACTIC
Other - Org Name:MOUNTAIN STAR INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-472-3434
Mailing Address - Street 1:3924 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3924 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 10
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4504
Practice Address - Country:US
Practice Address - Phone:505-990-6954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN STAR INJURY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center