Provider Demographics
NPI:1417631714
Name:GLASS CITY SPINE
Entity Type:Organization
Organization Name:GLASS CITY SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-472-2610
Mailing Address - Street 1:4333 MONROE STREET
Mailing Address - Street 2:SUITE D/E
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-472-2610
Mailing Address - Fax:
Practice Address - Street 1:4333 MONROE STREET
Practice Address - Street 2:SUITE D/E
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-472-2610
Practice Address - Fax:419-472-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty