Healthcare Provider Details

I. General information

NPI: 1043734403
Provider Name (Legal Business Name): BACKBONE FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE STE 121B
ALBUQUERQUE NM
87112-1869
US

IV. Provider business mailing address

2901 JUAN TABO BLVD NE STE 121B
ALBUQUERQUE NM
87112-1869
US

V. Phone/Fax

Practice location:
  • Phone: 15056978062
  • Fax:
Mailing address:
  • Phone: 15056978062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2161
License Number StateNM

VIII. Authorized Official

Name: EMILY BUTTERFIELD
Title or Position: OPERATIONS MANAGER
Credential: PHD
Phone: 602-291-3261