Provider Demographics
NPI:1649686361
Name:SPEEGLE, NICK (DC)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:SPEEGLE
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 1:6751 ACADEMY RD NE
Mailing Address - Street 2:STE. C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3386
Mailing Address - Country:US
Mailing Address - Phone:505-503-8376
Mailing Address - Fax:505-312-7193
Practice Address - Street 1:6751 ACADEMY RD NE
Practice Address - Street 2:STE. C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3386
Practice Address - Country:US
Practice Address - Phone:505-503-8376
Practice Address - Fax:505-312-7193
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2103111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician