Provider Demographics
NPI:1013948512
Name:DAUGHERTY CHIROPRACTIC & FAMILY WELLNESS PC
Entity Type:Organization
Organization Name:DAUGHERTY CHIROPRACTIC & FAMILY WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-521-0022
Mailing Address - Street 1:648 N ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2131
Mailing Address - Country:US
Mailing Address - Phone:575-521-0022
Mailing Address - Fax:575-521-0033
Practice Address - Street 1:648 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2131
Practice Address - Country:US
Practice Address - Phone:575-521-0022
Practice Address - Fax:575-521-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521176Medicare PIN