Provider Demographics
NPI:1528405198
Name:MANCHESTER SPINE CENTER, LLC
Entity Type:Organization
Organization Name:MANCHESTER SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-204-2888
Mailing Address - Street 1:364 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4440
Mailing Address - Country:US
Mailing Address - Phone:301-204-2888
Mailing Address - Fax:
Practice Address - Street 1:364 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4440
Practice Address - Country:US
Practice Address - Phone:301-204-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty