1760677207 NPI number — ADVANCED MOVEMENT CHIROPRACTIC INC.

Table of content: (NPI 1760677207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760677207 NPI number — ADVANCED MOVEMENT CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MOVEMENT CHIROPRACTIC INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760677207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 FEATHER ROCK PL NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87114-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-301-8439
Provider Business Mailing Address Fax Number:
888-677-9456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 SAN MATEO BLVD NE STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-3163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-888-4044
Provider Business Practice Location Address Fax Number:
505-888-1932
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRABOLD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-301-8439

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  NM00KJ55 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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