Provider Demographics
NPI:1639472228
Name:ULTIMATE SPINAL ANALYSIS PA
Entity Type:Organization
Organization Name:ULTIMATE SPINAL ANALYSIS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:GLANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC DAAMLP DRIT
Authorized Official - Phone:855-872-9729
Mailing Address - Street 1:1392 SWEETGUM CIR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3202
Mailing Address - Country:US
Mailing Address - Phone:855-872-9729
Mailing Address - Fax:817-514-0343
Practice Address - Street 1:1392 SWEETGUM CIR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3202
Practice Address - Country:US
Practice Address - Phone:855-872-9729
Practice Address - Fax:817-514-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7229291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory