Healthcare Provider Details

I. General information

NPI: 1497929665
Provider Name (Legal Business Name): JOSHUA RAPHAEL PHELPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3688
US

IV. Provider business mailing address

7100 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3688
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-5858
  • Fax:
Mailing address:
  • Phone: 505-883-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1710
License Number StateNM

VIII. Authorized Official

Name: DR. JOSHUA RAPHAEL PHELPS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 505-977-0921