Healthcare Provider Details

I. General information

NPI: 1497889620
Provider Name (Legal Business Name): NEW MEXICO CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 MONTGOMERY BLVD NE BLDG 1 STE 30
ALBUQUERQUE NM
87111-3857
US

IV. Provider business mailing address

10555 MONTGOMERY BLVD NE BLDG 1 STE 30
ALBUQUERQUE NM
87111-3857
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-6622
  • Fax: 505-323-4419
Mailing address:
  • Phone: 505-299-6622
  • Fax: 505-323-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1621
License Number StateNM

VIII. Authorized Official

Name: MS. GRETCHEN YANZ KIRKWOOD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-299-6622