Provider Demographics
NPI:1093890220
Name:BYRD, ROBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:BYRD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1110 PENNSYLVANIA ST NE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7404
Mailing Address - Country:US
Mailing Address - Phone:505-268-0808
Mailing Address - Fax:505-268-2458
Practice Address - Street 1:7611 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5405
Practice Address - Country:US
Practice Address - Phone:505-268-0808
Practice Address - Fax:505-268-2458
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM1009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM1009OtherNEW MEXICO LICENSE NUMBER
NMNM01K682OtherBLUE CROSS/BLUE SHIELD
NM20-2403308OtherFEDERAL TAX ID NUMBER