Provider Demographics
NPI:1437436045
Name:SPINAL HEALTHCARE AND PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:SPINAL HEALTHCARE AND PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLASSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-493-6565
Mailing Address - Street 1:108 LANDIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1168
Mailing Address - Country:US
Mailing Address - Phone:260-493-6565
Mailing Address - Fax:260-493-6567
Practice Address - Street 1:108 LANDIN RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1168
Practice Address - Country:US
Practice Address - Phone:260-493-6565
Practice Address - Fax:260-493-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018040A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty