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General NPI Number Information
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NPI Number | 1093160574
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Entity Type | Organization
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Legal Business Name | BACK PAIN RELIEF CHIROPRACTIC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 1108 S 13TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-2670
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Country | US
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Telephone | 575-746-6375
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Fax | 575-746-6799
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Provider Business Mailing Address
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Address Line | 1108 S 13TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-2670
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Country | US
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Telephone | 575-746-6375
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Fax | 575-746-6799
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | THOMAS MARK ANDREWS
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Credential | D.C.
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Telephone | 575-746-6375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2061
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License Number State | NM
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