Provider Demographics
NPI:1649798810
Name:DESERT HILLS CHIROPRACTIC, PA
Entity type:Organization
Organization Name:DESERT HILLS CHIROPRACTIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:WINGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-634-9225
Mailing Address - Street 1:1700 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6331
Mailing Address - Country:US
Mailing Address - Phone:505-634-9225
Mailing Address - Fax:505-212-1195
Practice Address - Street 1:1700 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6331
Practice Address - Country:US
Practice Address - Phone:505-634-9225
Practice Address - Fax:505-212-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty