Provider Demographics
NPI:1598958860
Name:ACCIDENT BACK & NECK CARE CENTER, INC
Entity Type:Organization
Organization Name:ACCIDENT BACK & NECK CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-268-0808
Mailing Address - Street 1:1110 PENNSYLVANIA ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7402
Mailing Address - Country:US
Mailing Address - Phone:505-268-0808
Mailing Address - Fax:505-268-2458
Practice Address - Street 1:1110 PENNSYLVANIA NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7404
Practice Address - Country:US
Practice Address - Phone:505-268-0808
Practice Address - Fax:505-268-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM1009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521227Medicare PIN
NMT75019Medicare UPIN