Provider Demographics
NPI:1609992601
Name:RIO PECOS CHIROPRACTIC WELLNESS CENTER LLC
Entity type:Organization
Organization Name:RIO PECOS CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-234-1293
Mailing Address - Street 1:2424 BONITA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3152
Mailing Address - Country:US
Mailing Address - Phone:505-234-1293
Mailing Address - Fax:505-234-1294
Practice Address - Street 1:2424 BONITA ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3152
Practice Address - Country:US
Practice Address - Phone:505-234-1293
Practice Address - Fax:505-234-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1679641047OtherNPI-DR. ERIC J CAMPOS, DC
NM=========OtherEIN