Provider Demographics
NPI:1609179761
Name:REINECKE-HRISTOV, LISA RENEE (CNP, DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:REINECKE-HRISTOV
Suffix:
Gender:F
Credentials:CNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7529
Mailing Address - Country:US
Mailing Address - Phone:575-623-3155
Mailing Address - Fax:
Practice Address - Street 1:602 E COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-7529
Practice Address - Country:US
Practice Address - Phone:575-623-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1051111N00000X
NMCNP-03567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor