Healthcare Provider Details

I. General information

NPI: 1629232111
Provider Name (Legal Business Name): JOSEPH VERNON EDWARDS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 SEQUOIA RD NW SUITE 200
ALBUQUERQUE NM
87120-1284
US

IV. Provider business mailing address

5300 SEQUOIA RD NW SUITE 200
ALBUQUERQUE NM
87120-1284
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-3771
  • Fax: 505-836-5282
Mailing address:
  • Phone: 505-836-3771
  • Fax: 505-836-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: