Provider Demographics
NPI:1316193204
Name:SPINE & SPORT CHIROPRACTIC
Entity Type:Organization
Organization Name:SPINE & SPORT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-754-4227
Mailing Address - Street 1:701 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-1605
Mailing Address - Country:US
Mailing Address - Phone:712-754-4227
Mailing Address - Fax:712-754-3889
Practice Address - Street 1:701 3RD AVE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1605
Practice Address - Country:US
Practice Address - Phone:712-754-4227
Practice Address - Fax:712-754-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty