Provider Demographics
NPI:1245592419
Name:LOWELL SPINE AND PAIN ASSOCIATES
Entity Type:Organization
Organization Name:LOWELL SPINE AND PAIN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-937-6460
Mailing Address - Street 1:2 HOSPITAL DR FL 2
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1311
Mailing Address - Country:US
Mailing Address - Phone:978-937-6460
Mailing Address - Fax:
Practice Address - Street 1:2 HOSPITAL DR FL 2
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1311
Practice Address - Country:US
Practice Address - Phone:978-937-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242530208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty