Provider Demographics
NPI:1477968113
Name:NOVA SPINAL REHABILITION LLC
Entity Type:Organization
Organization Name:NOVA SPINAL REHABILITION LLC
Other - Org Name:OREGON SPINE AND DISC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-896-6380
Mailing Address - Street 1:6163 SW MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4421
Mailing Address - Country:US
Mailing Address - Phone:503-626-3700
Mailing Address - Fax:503-643-6667
Practice Address - Street 1:6163 SW MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4421
Practice Address - Country:US
Practice Address - Phone:503-626-3700
Practice Address - Fax:503-643-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty