Healthcare Provider Details

I. General information

NPI: 1831101021
Provider Name (Legal Business Name): CHRISTOPHER C. CECIL D.C., FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 UNIVERSITY BLVD NE STE A
ALBUQUERQUE NM
87102-1716
US

IV. Provider business mailing address

1415 UNIVERSITY BLVD NE STE A
ALBUQUERQUE NM
87102-1716
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-1313
  • Fax: 505-842-5683
Mailing address:
  • Phone: 505-243-1313
  • Fax: 505-842-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1057
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: