Provider Demographics
NPI:1437249489
Name:PHYSICIANS NECK AND BACK CLINICS PA
Entity Type:Organization
Organization Name:PHYSICIANS NECK AND BACK CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-639-9150
Mailing Address - Street 1:3050 CENTRE POINTE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-639-9150
Mailing Address - Fax:651-639-9153
Practice Address - Street 1:3050 CENTRE POINTE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-639-9150
Practice Address - Fax:651-639-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty