Provider Demographics
NPI:1568684074
Name:ROLWING CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROLWING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ROLWING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-315-0224
Mailing Address - Street 1:P.O. BOX 40488
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87196-0488
Mailing Address - Country:US
Mailing Address - Phone:505-315-0224
Mailing Address - Fax:
Practice Address - Street 1:201 DARTMOUTH DR. SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2219
Practice Address - Country:US
Practice Address - Phone:505-315-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00075233Medicaid
NM00075233Medicaid