Provider Demographics
NPI:1932317666
Name:SPINALAID, LLC
Entity Type:Organization
Organization Name:SPINALAID, LLC
Other - Org Name:TEAM CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:DETTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-272-4100
Mailing Address - Street 1:106 N STATE ROAD 267
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8475
Mailing Address - Country:US
Mailing Address - Phone:317-272-4100
Mailing Address - Fax:317-272-4110
Practice Address - Street 1:106 N STATE ROAD 267
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8475
Practice Address - Country:US
Practice Address - Phone:317-272-4100
Practice Address - Fax:317-272-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000607A111N00000X, 111NR0200X
IN01017401207Q00000X
IN99018585A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty