Healthcare Provider Details

I. General information

NPI: 1093890220
Provider Name (Legal Business Name): ROBERT E BYRD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 INDIAN SCHOOL RD NE SUITE 104
ALBUQUERQUE NM
87110-5405
US

IV. Provider business mailing address

1110 PENNSYLVANIA ST NE STE A
ALBUQUERQUE NM
87110-7404
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0808
  • Fax: 505-268-2458
Mailing address:
  • Phone: 505-268-0808
  • Fax: 505-268-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNM1009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: