Provider Demographics
NPI:1760612568
Name:REFORM SPINE & INJURY CARE CENTER
Entity Type:Organization
Organization Name:REFORM SPINE & INJURY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT, LMT
Authorized Official - Phone:505-821-4325
Mailing Address - Street 1:701 OSUNA RD. NE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113
Mailing Address - Country:US
Mailing Address - Phone:505-821-4325
Mailing Address - Fax:505-822-8460
Practice Address - Street 1:701 OSUNA RD NE
Practice Address - Street 2:SUITE 700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1384
Practice Address - Country:US
Practice Address - Phone:505-821-4325
Practice Address - Fax:505-822-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0083174400000X
NMR35692174400000X
NM5384174400000X
NM5075174400000X
NM3703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty