Provider Demographics
NPI:1437709110
Name:MIAMI VALLEY SPINE AND JOINT LLC
Entity Type:Organization
Organization Name:MIAMI VALLEY SPINE AND JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-310-1410
Mailing Address - Street 1:2011 S LAKEMAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2315
Mailing Address - Country:US
Mailing Address - Phone:937-310-1410
Mailing Address - Fax:937-310-1406
Practice Address - Street 1:2011 S LAKEMAN DR STE D
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-2315
Practice Address - Country:US
Practice Address - Phone:937-310-1410
Practice Address - Fax:937-310-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH445331Medicaid
OH13644841OtherCAQH