Enchantment Upper Cervical LLC
Organization Active NPI Chiropractor · Corrales, NM
NPI 1164130548 · NPPES record last updated Nov 14, 2022
Key facts
- NPI
- 1164130548
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- ENCHANTMENT UPPER CERVICAL LLC
- Practice address
- 2469 Corrales Rd Ste E
Corrales, NM 87048-9148 - Phone
- (505) 589-9571
- NPI assigned
- Nov 14, 2022
- Organization subpart
- No
Authorized official
- Name
- Olivia Gurule-Rietmann, DC
- Title
- Owner
- Phone
- (505) 589-9571
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231106003138 | NM | Part B Supplier - Clinic/Group Practice | 2961859434 |
Receives reassigned benefits from 1 practitioner Practice locations: Corrales, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
2469 Corrales Rd Ste E
Corrales, NM 87048-9148
Mailing address
5601 Tioga Rd NW
Albuquerque, NM 87120-2352
Phone (505) 435-2870
Other names
- Enchantment Upper Cervical Chiropractic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | info@enchantmentuppercervical.com | Health Information Exchange (HIE) |
Other providers in Corrales, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.