Provider Demographics
NPI:1619319969
Name:CONZO, JOSHUA SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SCOTT
Last Name:CONZO
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 1:9641 DE VARGAS LOOP NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6373
Mailing Address - Country:US
Mailing Address - Phone:505-553-3154
Mailing Address - Fax:
Practice Address - Street 1:7930 WYOMING BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6018
Practice Address - Country:US
Practice Address - Phone:505-247-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10953111N00000X
NM2085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor