Provider Demographics
NPI:1023168473
Name:SANDOVAL CHIROPRACTIC HEALTH CENTER, INC
Entity type:Organization
Organization Name:SANDOVAL CHIROPRACTIC HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-325-3355
Mailing Address - Street 1:4251 E MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8639
Mailing Address - Country:US
Mailing Address - Phone:505-325-3355
Mailing Address - Fax:505-325-4479
Practice Address - Street 1:4251 E MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8639
Practice Address - Country:US
Practice Address - Phone:505-325-3355
Practice Address - Fax:505-325-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty