Provider Demographics
NPI:1275664948
Name:SPINAL CARE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:SPINAL CARE MANAGEMENT, INC.
Other - Org Name:MAPLE RIDGE SPINAL PAIN CENTER--SALT LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYGANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-301-0351
Mailing Address - Street 1:505 E 200 S
Mailing Address - Street 2:SUITE 425
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2022
Mailing Address - Country:US
Mailing Address - Phone:801-363-0060
Mailing Address - Fax:
Practice Address - Street 1:505 E 200 S
Practice Address - Street 2:SUITE 425
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2022
Practice Address - Country:US
Practice Address - Phone:801-363-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty