Provider Demographics
NPI:1225183478
Name:SPINAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:SPINAL SOLUTIONS LLC
Other - Org Name:CHIROPRACTIC PHYSIOTHERAPY CLINIC OF WEST DES MOINES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ERTL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-791-2323
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:101 1ST AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3700
Practice Address - Country:US
Practice Address - Phone:641-791-2323
Practice Address - Fax:641-791-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0760835Medicaid
IAU99818Medicare UPIN
IAI19378Medicare PIN