Healthcare Provider Details

I. General information

NPI: 1902836067
Provider Name (Legal Business Name): DAVID BIGDEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE SUITE S
ALBUQUERQUE NM
87107-4565
US

IV. Provider business mailing address

6623 TIERRA PRIETA AVE NW
ALBUQUERQUE NM
87120-4978
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-2900
  • Fax:
Mailing address:
  • Phone: 505-836-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: