Provider Demographics
NPI:1477733582
Name:SPINALIGN PC
Entity Type:Organization
Organization Name:SPINALIGN PC
Other - Org Name:WARREN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-679-0100
Mailing Address - Street 1:5432 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-1960
Mailing Address - Country:US
Mailing Address - Phone:574-679-0100
Mailing Address - Fax:574-675-9586
Practice Address - Street 1:5432 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-1960
Practice Address - Country:US
Practice Address - Phone:574-679-0100
Practice Address - Fax:574-675-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN168920OtherMEDICARE
IN100468590Medicaid
IN000000089524OtherANTHEM
IN100468590Medicaid