Provider Demographics
NPI:1346567518
Name:SPINE & JOINT CENTER OF SOUTHWEST INDIANA, LLC
Entity Type:Organization
Organization Name:SPINE & JOINT CENTER OF SOUTHWEST INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-486-6294
Mailing Address - Street 1:1211 S MERIDIAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4228
Mailing Address - Country:US
Mailing Address - Phone:812-254-2203
Mailing Address - Fax:812-254-2033
Practice Address - Street 1:1211 S MERIDIAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4228
Practice Address - Country:US
Practice Address - Phone:812-254-2203
Practice Address - Fax:812-254-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002488A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty