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Organization

ADVANCED CHIROPRACTIC CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JONATHON QUALLS DC (CHIROPRACTIC PHYSICIAN/MEMBER)
(505) 334-5004
Entity
Organization

Contact information

Practice address
1415 W AZTEC BLVD, STE 4, AZTEC, NM 87410-1868
(505) 334-5004
(505) 334-8077
Mailing address
1415 W AZTEC BLVD, STE 4, AZTEC, NM 87410-1868
(505) 334-5004
(505) 334-8077

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2109
NM

Other

Enumeration date
10/03/2014
Last updated
10/03/2014
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