Provider Demographics
NPI:1760677207
Name:ADVANCED MOVEMENT CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:ADVANCED MOVEMENT CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:V
Authorized Official - Last Name:TRABOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-301-8439
Mailing Address - Street 1:5301 FEATHER ROCK PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4197
Mailing Address - Country:US
Mailing Address - Phone:505-301-8439
Mailing Address - Fax:888-677-9456
Practice Address - Street 1:2620 SAN MATEO BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3163
Practice Address - Country:US
Practice Address - Phone:505-888-4044
Practice Address - Fax:505-888-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM00KJ55111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty