Provider Demographics
NPI:1548585268
Name:PRIDHAM, MICHAEL ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:PRIDHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SAN PEDRO DR NE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3334
Mailing Address - Country:US
Mailing Address - Phone:505-872-1900
Mailing Address - Fax:505-881-2129
Practice Address - Street 1:2730 SAN PEDRO DR NE
Practice Address - Street 2:SUITE B-1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3334
Practice Address - Country:US
Practice Address - Phone:505-872-1900
Practice Address - Fax:505-881-2129
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor