Provider Demographics
NPI:1558587345
Name:LA MESA CHIROPRACTIC AND REHABILITATION CENTER INC.
Entity Type:Organization
Organization Name:LA MESA CHIROPRACTIC AND REHABILITATION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROWSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-327-4845
Mailing Address - Street 1:2904 HUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4564
Mailing Address - Country:US
Mailing Address - Phone:505-327-4845
Mailing Address - Fax:505-327-6274
Practice Address - Street 1:2904 HUTTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4564
Practice Address - Country:US
Practice Address - Phone:505-327-4845
Practice Address - Fax:505-327-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty