Provider Demographics
NPI:1780006247
Name:GLASS CITY SPINE AND REHAB INC.
Entity Type:Organization
Organization Name:GLASS CITY SPINE AND REHAB INC.
Other - Org Name:GLASS CITY INJURY AND REHAB INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOLLINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-472-2610
Mailing Address - Street 1:4333 MONROE ST
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1981
Mailing Address - Country:US
Mailing Address - Phone:419-472-2610
Mailing Address - Fax:419-472-2611
Practice Address - Street 1:4333 MONROE ST
Practice Address - Street 2:SUITE D & E
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1981
Practice Address - Country:US
Practice Address - Phone:419-472-2610
Practice Address - Fax:419-472-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty