Healthcare Provider Details

I. General information

NPI: 1720460520
Provider Name (Legal Business Name): ALEXANDER CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 WYOMING BLVD NE
ALBUQUERQUE NM
87111-3205
US

IV. Provider business mailing address

3800 WYOMING BLVD NE
ALBUQUERQUE NM
87111-3205
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-1639
  • Fax: 505-296-5610
Mailing address:
  • Phone: 505-296-1639
  • Fax: 505-296-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1179
License Number StateNM

VIII. Authorized Official

Name: DR. BLAIR THEODORE ALEXANDER
Title or Position: OWNER
Credential: D.C.
Phone: 505-296-1639