Healthcare Provider Details

I. General information

NPI: 1750598686
Provider Name (Legal Business Name): INTEGRATIVE MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7651
US

IV. Provider business mailing address

8324 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7651
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-3648
  • Fax: 505-256-9778
Mailing address:
  • Phone: 505-256-3648
  • Fax: 505-256-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT C JONES
Title or Position: OWNER
Credential: D.C.
Phone: 505-256-3648