Provider Demographics
NPI:1396169744
Name:SPINE TEAM CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SPINE TEAM CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-508-2369
Mailing Address - Street 1:701 OSUNA RD NE STE 600
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-0009
Mailing Address - Country:US
Mailing Address - Phone:505-508-2369
Mailing Address - Fax:505-508-2523
Practice Address - Street 1:701 OSUNA RD NE STE 600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-0009
Practice Address - Country:US
Practice Address - Phone:505-508-2369
Practice Address - Fax:505-508-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2088OtherCHIROPRACTOR