Provider Demographics
NPI:1578154456
Name:ALIGN THE SPINE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ALIGN THE SPINE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MCSP
Authorized Official - Phone:217-855-1917
Mailing Address - Street 1:W225N3799 LONG VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4184
Mailing Address - Country:US
Mailing Address - Phone:414-429-9707
Mailing Address - Fax:
Practice Address - Street 1:W225N3799 LONG VALLEY CT
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4184
Practice Address - Country:US
Practice Address - Phone:414-429-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty