Provider Demographics
NPI:1588220024
Name:SPINE TYME CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:SPINE TYME CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHASTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-474-4069
Mailing Address - Street 1:2601 BEMISS RD STE Q
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1450
Mailing Address - Country:US
Mailing Address - Phone:229-474-4069
Mailing Address - Fax:
Practice Address - Street 1:2601 BEMISS RD STE Q
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1450
Practice Address - Country:US
Practice Address - Phone:229-474-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0