Provider Demographics
NPI:1508570094
Name:SPINE WELLNESS & REHAB LLC
Entity Type:Organization
Organization Name:SPINE WELLNESS & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-916-0476
Mailing Address - Street 1:19060 Q ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1504
Mailing Address - Country:US
Mailing Address - Phone:402-577-0236
Mailing Address - Fax:
Practice Address - Street 1:19060 Q ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1504
Practice Address - Country:US
Practice Address - Phone:402-577-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty