Healthcare Provider Details

I. General information

NPI: 1235201401
Provider Name (Legal Business Name): JAMES M VANDERLOOP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 MONTE VISTA BLVD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

3216 MONTE VISTA BLVD NE
ALBUQUERQUE NM
87106-2120
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4325
  • Fax:
Mailing address:
  • Phone: 505-247-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: