Provider Demographics
NPI:1467634428
Name:HEALTHY SPINE, LLC
Entity Type:Organization
Organization Name:HEALTHY SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-759-0875
Mailing Address - Street 1:5800 SAMPSON DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3513
Mailing Address - Country:US
Mailing Address - Phone:330-759-0875
Mailing Address - Fax:
Practice Address - Street 1:1250 YOUNGSTOWN WARREN RD
Practice Address - Street 2:BLD 1, SUITE B
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4649
Practice Address - Country:US
Practice Address - Phone:330-652-4978
Practice Address - Fax:330-652-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty