Provider Demographics
NPI:1679760649
Name:HILLIARD CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:HILLIARD CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-356-6982
Mailing Address - Street 1:112 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6305
Mailing Address - Country:US
Mailing Address - Phone:505-356-6982
Mailing Address - Fax:505-356-3773
Practice Address - Street 1:112 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6305
Practice Address - Country:US
Practice Address - Phone:505-356-6982
Practice Address - Fax:505-356-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK860OtherBLUECROSS/BLUESHIELD
NM0000K737Medicaid
NMK860OtherBLUECROSS/BLUESHIELD