Healthcare Provider Details

I. General information

NPI: 1821427261
Provider Name (Legal Business Name): DESERT MOTIONS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EUBANK BLVD NE SUITE 6
ALBUQUERQUE NM
87112-5386
US

IV. Provider business mailing address

1201 EUBANK BLVD NE SUITE 6
ALBUQUERQUE NM
87112-5386
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-1101
  • Fax: 505-883-0629
Mailing address:
  • Phone: 505-883-1101
  • Fax: 505-883-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2074
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2074
License Number StateNM

VIII. Authorized Official

Name: DR. GAIL MARIE BRADLEY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 505-883-1011