Provider Demographics
NPI:1215044391
Name:SOVEREIGN, CHRISTOPHER WILLIAM (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:SOVEREIGN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:1101 CARDENAS DR NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6650
Mailing Address - Country:US
Mailing Address - Phone:505-254-0022
Mailing Address - Fax:505-254-0022
Practice Address - Street 1:1101 CARDENAS DR NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6650
Practice Address - Country:US
Practice Address - Phone:505-254-0022
Practice Address - Fax:505-254-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist