Provider Demographics
NPI:1437601028
Name:ADJUSTED CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ADJUSTED CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-333-7929
Mailing Address - Street 1:1409 W AZTEC BLVD
Mailing Address - Street 2:8
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-4709
Mailing Address - Country:US
Mailing Address - Phone:505-333-7929
Mailing Address - Fax:505-333-7931
Practice Address - Street 1:1409 W AZTEC BLVD
Practice Address - Street 2:8
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-4709
Practice Address - Country:US
Practice Address - Phone:505-333-7929
Practice Address - Fax:505-333-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty