Healthcare Provider Details

I. General information

NPI: 1467580563
Provider Name (Legal Business Name): NANCY NORTH D.C.,C.C.S.P., C.C.E
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 SPAIN RD NE STE C
ALBUQUERQUE NM
87111-1898
US

IV. Provider business mailing address

11001 SPAIN RD NE STE C
ALBUQUERQUE NM
87111-1898
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-7474
  • Fax: 505-294-7939
Mailing address:
  • Phone: 505-294-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1596
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: