Provider Demographics
NPI:1518988153
Name:SPINE & DISC REHABILITATION INC.
Entity Type:Organization
Organization Name:SPINE & DISC REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KLINTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-639-9950
Mailing Address - Street 1:6611 AMMON ROAD
Mailing Address - Street 2:
Mailing Address - City:FORD
Mailing Address - State:VA
Mailing Address - Zip Code:23850
Mailing Address - Country:US
Mailing Address - Phone:804-265-9232
Mailing Address - Fax:804-639-9970
Practice Address - Street 1:6709 LAKE HARBOUR DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2083
Practice Address - Country:US
Practice Address - Phone:804-639-9950
Practice Address - Fax:804-639-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty