Healthcare Provider Details

I. General information

NPI: 1467638478
Provider Name (Legal Business Name): MARK L. SCHWARTZ, DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK BLVD NE SUITE 107
ALBUQUERQUE NM
87111-3479
US

IV. Provider business mailing address

4550 EUBANK BLVD NE SUITE 107
ALBUQUERQUE NM
87111-3479
US

V. Phone/Fax

Practice location:
  • Phone: 505-332-1006
  • Fax: 505-332-0400
Mailing address:
  • Phone: 505-332-1006
  • Fax: 505-332-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1504
License Number StateNM

VIII. Authorized Official

Name: DR. MARK L SCHWARTZ
Title or Position: PRESIDENT
Credential: DC
Phone: 505-332-1006