Provider Demographics
NPI:1134798887
Name:BRINZA SPINE AND SPORT LLC
Entity type:Organization
Organization Name:BRINZA SPINE AND SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINZA
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:812-243-9257
Mailing Address - Street 1:15338 KINGSWAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7435
Mailing Address - Country:US
Mailing Address - Phone:812-243-9257
Mailing Address - Fax:
Practice Address - Street 1:2136 EAST MARGARET DR.
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3337
Practice Address - Country:US
Practice Address - Phone:812-243-9257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1144787987Medicaid