Provider Demographics
NPI:1710483136
Name:SPINE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SPINE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-642-7906
Mailing Address - Street 1:9135 PISCATAWAY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2566
Mailing Address - Country:US
Mailing Address - Phone:240-244-2818
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD STE 310
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2566
Practice Address - Country:US
Practice Address - Phone:240-244-2818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty