Provider Demographics
NPI:1538462106
Name:GOLDSBORO SPINE CENTER, PA
Entity Type:Organization
Organization Name:GOLDSBORO SPINE CENTER, PA
Other - Org Name:GOLDSBORO SPINE CENTER, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INCORPORATOR/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR GAMBACORTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-751-0555
Mailing Address - Street 1:605 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4263
Mailing Address - Country:US
Mailing Address - Phone:919-751-0555
Mailing Address - Fax:919-751-3001
Practice Address - Street 1:605 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4263
Practice Address - Country:US
Practice Address - Phone:919-751-0555
Practice Address - Fax:919-751-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty