Provider Demographics
NPI:1205163854
Name:FULL CIRCLE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:FULL CIRCLE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUTLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-722-9002
Mailing Address - Street 1:108 W HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6218
Mailing Address - Country:US
Mailing Address - Phone:505-722-9002
Mailing Address - Fax:505-722-7031
Practice Address - Street 1:108 W HILL AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6218
Practice Address - Country:US
Practice Address - Phone:505-722-9002
Practice Address - Fax:505-722-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty