Healthcare Provider Details

I. General information

NPI: 1609533249
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1102
US

IV. Provider business mailing address

4127 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1102
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-8885
  • Fax: 505-308-8886
Mailing address:
  • Phone: 505-308-8885
  • Fax: 505-308-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR ALEXIS BLACKFORD ANDERSON
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 505-308-8885