Provider Demographics
NPI:1548802861
Name:PRECISION SPINE AND WELLNESS CLINIC,LLC
Entity Type:Organization
Organization Name:PRECISION SPINE AND WELLNESS CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEBEDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-875-4560
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:240-833-2943
Mailing Address - Fax:
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 107
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:240-833-2943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION SPINE AND WELLNESS CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty