Provider Demographics
NPI:1427486877
Name:ACTIVE CHIROPRACTIC SPINE & JOINT CENTER, LLC
Entity type:Organization
Organization Name:ACTIVE CHIROPRACTIC SPINE & JOINT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HORDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-699-4594
Mailing Address - Street 1:7007 WYOMING BLVD NE STE A3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6941
Mailing Address - Country:US
Mailing Address - Phone:505-699-4594
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE STE A3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6941
Practice Address - Country:US
Practice Address - Phone:505-699-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty