Healthcare Provider Details

I. General information

NPI: 1396169744
Provider Name (Legal Business Name): SPINE TEAM CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

IV. Provider business mailing address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-2369
  • Fax: 505-508-2523
Mailing address:
  • Phone: 505-508-2369
  • Fax: 505-508-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2088
License Number StateNM

VIII. Authorized Official

Name: DR. CHRISTINA M LUJAN
Title or Position: CHIROPRACTIC PHYSICIAN / PRESIDENT
Credential: D.C.
Phone: 505-508-2369