Provider Demographics
NPI:1093160574
Name:BACK PAIN RELIEF CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK PAIN RELIEF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-746-6375
Mailing Address - Street 1:1108 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2670
Mailing Address - Country:US
Mailing Address - Phone:575-746-6375
Mailing Address - Fax:575-746-6799
Practice Address - Street 1:1108 S 13TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2670
Practice Address - Country:US
Practice Address - Phone:575-746-6375
Practice Address - Fax:575-746-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty