Provider Demographics
NPI:1073841326
Name:SPINAL BRACING, INC
Entity Type:Organization
Organization Name:SPINAL BRACING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-384-1634
Mailing Address - Street 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:STE 201
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:770-384-1634
Mailing Address - Fax:770-438-6172
Practice Address - Street 1:300 VILLAGE GREEN CIR SE
Practice Address - Street 2:STE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3476
Practice Address - Country:US
Practice Address - Phone:770-384-1634
Practice Address - Fax:770-438-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies