Provider Demographics
NPI:1922485440
Name:3D SCOLIOSIS BRACE, LLC
Entity Type:Organization
Organization Name:3D SCOLIOSIS BRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-679-0100
Mailing Address - Street 1:5432 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-1960
Mailing Address - Country:US
Mailing Address - Phone:574-679-0100
Mailing Address - Fax:574-675-9586
Practice Address - Street 1:5432 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-1960
Practice Address - Country:US
Practice Address - Phone:574-679-0100
Practice Address - Fax:574-675-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment