Provider Demographics
NPI:1831390939
Name:ACT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ACT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CLIN
Authorized Official - Last Name:TWITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-887-3263
Mailing Address - Street 1:710 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5808
Mailing Address - Country:US
Mailing Address - Phone:505-887-3263
Mailing Address - Fax:505-887-6296
Practice Address - Street 1:710 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5808
Practice Address - Country:US
Practice Address - Phone:505-887-3263
Practice Address - Fax:505-887-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1508948266OtherINDIVIDUAL NPI NUMBER
NM1831390939OtherBLUECROSS BLUE SHIELD
NMA2866Medicaid
NMU69209Medicare UPIN
NM300521035Medicare ID - Type Unspecified