Provider Demographics
NPI:1073727277
Name:SPINE & BRAIN GROUP SC
Entity Type:Organization
Organization Name:SPINE & BRAIN GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:I
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-843-1000
Mailing Address - Street 1:505 S 24TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-1706
Mailing Address - Country:US
Mailing Address - Phone:715-971-4019
Mailing Address - Fax:715-843-1001
Practice Address - Street 1:2800 WESTHILL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3771
Practice Address - Country:US
Practice Address - Phone:715-843-1000
Practice Address - Fax:715-843-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center