Healthcare Provider Details

I. General information

NPI: 1003988171
Provider Name (Legal Business Name): BODY BALANCE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 WESTERFELD DR NE
ALBUQUERQUE NM
87111-3462
US

IV. Provider business mailing address

3705 WESTERFELD DR NE
ALBUQUERQUE NM
87111-3462
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-6705
  • Fax:
Mailing address:
  • Phone: 505-275-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1515
License Number StateNM

VIII. Authorized Official

Name: DR. ALFRED WARNER SWEDBERG JR.
Title or Position: OWNER
Credential: D.O.
Phone: 505-275-6705