Provider Demographics
NPI:1154833655
Name:NEXT LEVEL SPORT AND SPINE LLC
Entity Type:Organization
Organization Name:NEXT LEVEL SPORT AND SPINE LLC
Other - Org Name:NEXT LEVEL SPORT & SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-440-6700
Mailing Address - Street 1:204 W HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3812
Mailing Address - Country:US
Mailing Address - Phone:330-440-6700
Mailing Address - Fax:330-440-6701
Practice Address - Street 1:204 W. HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663
Practice Address - Country:US
Practice Address - Phone:330-440-6700
Practice Address - Fax:330-440-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3732261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty