Healthcare Provider Details

I. General information

NPI: 1104297902
Provider Name (Legal Business Name): SPEEGLE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 ACADEMY RD NE STE. C
ALBUQUERQUE NM
87109-3386
US

IV. Provider business mailing address

6751 ACADEMY RD NE STE. C
ALBUQUERQUE NM
87109-3386
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8376
  • Fax: 505-312-7193
Mailing address:
  • Phone: 505-503-8376
  • Fax: 505-312-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2103
License Number StateNM

VIII. Authorized Official

Name: DR. NICK DAVID SPEEGLE
Title or Position: OWNER
Credential: DC
Phone: 505-280-1918