Provider Demographics
NPI:1619433133
Name:COMPETITIVE EDGE SPORTS AND SPINE LLC
Entity Type:Organization
Organization Name:COMPETITIVE EDGE SPORTS AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-651-8491
Mailing Address - Street 1:11590 MCKINLEY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11590 MCKINLEY HWY STE D
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9507
Practice Address - Country:US
Practice Address - Phone:574-651-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPETITIVE EDGE SPORTS AND SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty