Healthcare Provider Details

I. General information

NPI: 1205988060
Provider Name (Legal Business Name): GONSTEAD FAMILY CHIROPRACTIC OF ABQ - WESTSIDE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

1632 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-9444
  • Fax: 505-922-9150
Mailing address:
  • Phone: 505-922-9444
  • Fax: 505-922-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1290
License Number StateNM

VIII. Authorized Official

Name: DR. MICHAEL ROZENBLUM
Title or Position: PRESIDENT
Credential: DC
Phone: 505-922-9444