Provider Demographics
NPI:1235172552
Name:SPINE & NEUROMUSCULAR ASSOCIATES OF SEI PSC
Entity Type:Organization
Organization Name:SPINE & NEUROMUSCULAR ASSOCIATES OF SEI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CARRICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-537-5616
Mailing Address - Street 1:120 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1116
Mailing Address - Country:US
Mailing Address - Phone:812-537-5616
Mailing Address - Fax:812-537-1804
Practice Address - Street 1:120 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1116
Practice Address - Country:US
Practice Address - Phone:812-537-5616
Practice Address - Fax:812-537-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200266910AMedicaid