Provider Demographics
NPI:1487927489
Name:HEALTH QUEST WELLNESS BOSQUE, LLC
Entity type:Organization
Organization Name:HEALTH QUEST WELLNESS BOSQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY/MANAGING DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-869-2273
Mailing Address - Street 1:155 BOSQUE FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-8931
Mailing Address - Country:US
Mailing Address - Phone:505-869-2273
Mailing Address - Fax:505-869-9958
Practice Address - Street 1:155 BOSQUE FARMS BLVD
Practice Address - Street 2:
Practice Address - City:BOSQUE FARMS
Practice Address - State:NM
Practice Address - Zip Code:87068-8931
Practice Address - Country:US
Practice Address - Phone:505-869-2273
Practice Address - Fax:505-869-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty