Healthcare Provider Details

I. General information

NPI: 1801127105
Provider Name (Legal Business Name): SOUTHWEST CENTER FOR THE HEALING ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1591
US

IV. Provider business mailing address

7400 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1591
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-3165
  • Fax:
Mailing address:
  • Phone: 505-881-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN W KONGS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-881-3165