Provider Demographics
NPI:1952318867
Name:BEAR CANYON HEALTH CIRCLE
Entity Type:Organization
Organization Name:BEAR CANYON HEALTH CIRCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SEC. / TRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:OSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-888-1795
Mailing Address - Street 1:4800 JUAN TABO BLVD NE
Mailing Address - Street 2:STE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2627
Mailing Address - Country:US
Mailing Address - Phone:505-888-1795
Mailing Address - Fax:505-888-1904
Practice Address - Street 1:4800 JUAN TABO NE
Practice Address - Street 2:STE B
Practice Address - City:ALBUQ
Practice Address - State:NM
Practice Address - Zip Code:87111-2627
Practice Address - Country:US
Practice Address - Phone:505-888-1795
Practice Address - Fax:505-888-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1348111N00000X
NM1616111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300521092Medicare Oscar/Certification