Healthcare Provider Details

I. General information

NPI: 1720291396
Provider Name (Legal Business Name): BEN C MARKHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 EUBANK BLVD NE SUITE B1
ALBUQUERQUE NM
87111-1759
US

IV. Provider business mailing address

5200 EUBANK BLVD NE SUITE B1
ALBUQUERQUE NM
87111-1759
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-1050
  • Fax: 505-237-0113
Mailing address:
  • Phone: 505-237-1050
  • Fax: 505-237-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number538
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: