Provider Demographics
NPI:1760677314
Name:SPINE INSTITUTE OF SCHERERVILLE LLC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF SCHERERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-864-5700
Mailing Address - Street 1:833 W LINCOLN HWY
Mailing Address - Street 2:SUITE 310E
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1674
Mailing Address - Country:US
Mailing Address - Phone:219-864-5700
Mailing Address - Fax:219-864-5872
Practice Address - Street 1:833 W LINCOLN HWY
Practice Address - Street 2:SUITE 310E
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1674
Practice Address - Country:US
Practice Address - Phone:219-864-5700
Practice Address - Fax:219-864-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8002250A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8002250AOtherIN CHRIOPRACTIC LICENSE #
IN6250000001Medicare NSC
IN255100Medicare PIN