Provider Demographics
NPI:1942444856
Name:SPINALAID CENTERS OF RENO
Entity Type:Organization
Organization Name:SPINALAID CENTERS OF RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-336-3472
Mailing Address - Street 1:630 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2356
Mailing Address - Country:US
Mailing Address - Phone:775-336-3472
Mailing Address - Fax:775-284-4902
Practice Address - Street 1:630 SIERRA ROSE DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2356
Practice Address - Country:US
Practice Address - Phone:775-336-3472
Practice Address - Fax:775-284-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39900Medicare PIN
NV39902Medicare UPIN