1144331315 NPI number — HEALTHPLEX CHIROPRACTIC

Table of content: TREYTON A NO MOCCASIN (NPI 1538966601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144331315 NPI number — HEALTHPLEX CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHPLEX CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144331315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 GOLF COURSE RD
Provider Second Line Business Mailing Address:
SUITE C2A
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-792-3311
Provider Business Mailing Address Fax Number:
505-792-3314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 GOLF COURSE RD
Provider Second Line Business Practice Location Address:
SUITE C2A
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-792-3311
Provider Business Practice Location Address Fax Number:
505-792-3314
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CHIROPRACTOR,OWNER
Authorized Official Telephone Number:
505-792-3311

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1572 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1532 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM007022 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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