Provider Demographics
NPI:1326512849
Name:PALM SPRINGS SPINAL CARE, INC
Entity Type:Organization
Organization Name:PALM SPRINGS SPINAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESNER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-267-6960
Mailing Address - Street 1:3003 S CONGRESS AVE STE 1D
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2169
Mailing Address - Country:US
Mailing Address - Phone:561-619-3902
Mailing Address - Fax:561-619-3902
Practice Address - Street 1:3003 S CONGRESS AVE STE 1D
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2169
Practice Address - Country:US
Practice Address - Phone:561-619-3902
Practice Address - Fax:561-619-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty