Provider Demographics
NPI:1538111596
Name:SPINE RX MANAGEMENT CO
Entity Type:Organization
Organization Name:SPINE RX MANAGEMENT CO
Other - Org Name:SPINE AND SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-573-7746
Mailing Address - Street 1:4000 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3158
Mailing Address - Country:US
Mailing Address - Phone:614-573-7746
Mailing Address - Fax:614-573-7750
Practice Address - Street 1:4000 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3158
Practice Address - Country:US
Practice Address - Phone:614-573-7746
Practice Address - Fax:614-573-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty