Provider Demographics
NPI:1962684977
Name:WALL CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WALL CHIROPRACTIC, LLC
Other - Org Name:WALL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-466-1429
Mailing Address - Street 1:5 CALIENTE RD
Mailing Address - Street 2:STE 2B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9100
Mailing Address - Country:US
Mailing Address - Phone:505-466-1429
Mailing Address - Fax:505-466-1437
Practice Address - Street 1:5 CALIENTE RD
Practice Address - Street 2:STE 2B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9100
Practice Address - Country:US
Practice Address - Phone:505-466-1429
Practice Address - Fax:505-466-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center