Provider Demographics
NPI:1336307164
Name:HEALING ARTS CHIROPRACTIC AND NUTRITION CENTER
Entity Type:Organization
Organization Name:HEALING ARTS CHIROPRACTIC AND NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-220-3031
Mailing Address - Street 1:2105 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1626
Mailing Address - Country:US
Mailing Address - Phone:505-220-3031
Mailing Address - Fax:505-896-3242
Practice Address - Street 1:2105 GOLF COURSE RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1626
Practice Address - Country:US
Practice Address - Phone:505-220-3031
Practice Address - Fax:505-896-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty