Provider Demographics
NPI:1629378757
Name:RABURN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RABURN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:RABURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-736-3120
Mailing Address - Street 1:501 W DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2001
Mailing Address - Country:US
Mailing Address - Phone:575-736-3120
Mailing Address - Fax:575-736-3122
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2160
Practice Address - Country:US
Practice Address - Phone:575-736-3120
Practice Address - Fax:575-736-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty