Provider Demographics
NPI:1407620610
Name:SPRINGS SPINE & REHABILITATION LLC
Entity Type:Organization
Organization Name:SPRINGS SPINE & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-479-7428
Mailing Address - Street 1:1935 DOMINION WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1464
Mailing Address - Country:US
Mailing Address - Phone:719-623-5648
Mailing Address - Fax:877-479-7428
Practice Address - Street 1:1935 DOMINION WAY STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1464
Practice Address - Country:US
Practice Address - Phone:719-623-5648
Practice Address - Fax:877-479-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty