Provider Demographics
NPI:1295006633
Name:THE ALBUQUERQUE NECK & BACK PAIN CENTER, LLC
Entity Type:Organization
Organization Name:THE ALBUQUERQUE NECK & BACK PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-243-1313
Mailing Address - Street 1:1415 UNIVERSITY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1716
Mailing Address - Country:US
Mailing Address - Phone:505-243-1313
Mailing Address - Fax:505-842-5683
Practice Address - Street 1:1415 UNIVERSITY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1716
Practice Address - Country:US
Practice Address - Phone:505-243-1313
Practice Address - Fax:505-842-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty