Provider Demographics
NPI:1043889561
Name:MOVEMENT REDEFINED SPINE AND SPORT - BOSCOBEL LLC
Entity Type:Organization
Organization Name:MOVEMENT REDEFINED SPINE AND SPORT - BOSCOBEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CURRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-422-1817
Mailing Address - Street 1:109 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1519
Mailing Address - Country:US
Mailing Address - Phone:608-375-2411
Mailing Address - Fax:
Practice Address - Street 1:109 W OAK ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1519
Practice Address - Country:US
Practice Address - Phone:608-375-2411
Practice Address - Fax:608-526-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-19
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty