Healthcare Provider Details

I. General information

NPI: 1336153071
Provider Name (Legal Business Name): TIMOTHY BATEMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 BRIDGE BLVD SW
ALBUQUERQUE NM
87105-3061
US

IV. Provider business mailing address

2622 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-3130
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-1664
  • Fax: 505-242-1664
Mailing address:
  • Phone: 505-888-0331
  • Fax: 505-888-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1365
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: