Provider Demographics
NPI:1689844169
Name:BACK IN ACTION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-660-2080
Mailing Address - Street 1:1444 S SAINT FRANCIS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4229
Mailing Address - Country:US
Mailing Address - Phone:505-660-2080
Mailing Address - Fax:
Practice Address - Street 1:1444 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4229
Practice Address - Country:US
Practice Address - Phone:505-660-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00KL90OtherBLUE CROSS BLUE SHIELD
NM202021346OtherPRESBYTERIAN HEALTH PLAN
NM=========OtherLOVELACE HEALTH PLAN