MEDICARE: DR. MICHAEL ANDREW PRIDHAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1825	NM

General Provider Information

NPI Number	:	1548585268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANDREW PRIDHAM D.C.

Provider Business Mailing Address
First Line	:	2730 SAN PEDRO DR NE
Second Line	:	SUITE B-1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3334
Country	:	US
Telephone Number	:	505-872-1900
Fax Number	:	505-881-2129

Provider Business Practice Location Address
First Line	:	2730 SAN PEDRO DR NE
Second Line	:	SUITE B-1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3334
Country	:	US
Telephone Number	:	505-872-1900
Fax Number	:	505-881-2129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	07/02/2010

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