Provider Demographics
NPI:1497806442
Name:SPINAL HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SPINAL HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-623-2225
Mailing Address - Street 1:201 N NEVADA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1729
Mailing Address - Country:US
Mailing Address - Phone:505-623-2225
Mailing Address - Fax:505-623-1170
Practice Address - Street 1:201 N NEVADA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-1729
Practice Address - Country:US
Practice Address - Phone:505-623-2225
Practice Address - Fax:505-623-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1861454100OtherPROVIDER NPI
NM1438OtherSTATE LICENSE
NMNM00KK92OtherBLUE CROSS BLUE SHEILD
NMNM00KK92OtherBLUE CROSS BLUE SHEILD