Provider Demographics
NPI:1780821512
Name:SUNRISE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SUNRISE CHIROPRACTIC LLC
Other - Org Name:SUNRISE CHIROPRACTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LEHR
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-324-2880
Mailing Address - Street 1:409 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-324-2080
Mailing Address - Fax:505-324-9464
Practice Address - Street 1:409 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-324-2080
Practice Address - Fax:505-324-9464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1699261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center