Provider Demographics
NPI:1609010388
Name:SPINE & SPORT REHAB CENTER
Entity Type:Organization
Organization Name:SPINE & SPORT REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-285-1970
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2571
Mailing Address - Country:US
Mailing Address - Phone:508-285-1970
Mailing Address - Fax:508-285-1972
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2571
Practice Address - Country:US
Practice Address - Phone:508-285-1970
Practice Address - Fax:508-285-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty