Provider Demographics
NPI:1073075271
Name:JAMESTOWN SPINE, LLC
Entity Type:Organization
Organization Name:JAMESTOWN SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:OGNIBENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-483-6800
Mailing Address - Street 1:1719 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-483-6800
Mailing Address - Fax:716-487-2796
Practice Address - Street 1:1719 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-483-6800
Practice Address - Fax:716-487-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty