Healthcare Provider Details

I. General information

NPI: 1427486877
Provider Name (Legal Business Name): ACTIVE CHIROPRACTIC SPINE & JOINT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 01/27/2023
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WYOMING BLVD NE STE A3
ALBUQUERQUE NM
87109-6941
US

IV. Provider business mailing address

7007 WYOMING BLVD NE STE A3
ALBUQUERQUE NM
87109-6941
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-4594
  • Fax:
Mailing address:
  • Phone: 505-699-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: PAUL HORDES
Title or Position: OWNER
Credential: D.C.
Phone: 505-699-4594