Provider Demographics
NPI:1205079696
Name:THE SPINE AND HEALTH CENTER
Entity type:Organization
Organization Name:THE SPINE AND HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-772-9836
Mailing Address - Street 1:310 SEVEN FIELDS BLVD
Mailing Address - Street 2:SUITE 130, BOX 10
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4307
Mailing Address - Country:US
Mailing Address - Phone:724-772-9833
Mailing Address - Fax:724-772-9837
Practice Address - Street 1:310 SEVEN FIELDS BLVD
Practice Address - Street 2:SUITE 130, BOX 10
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-4307
Practice Address - Country:US
Practice Address - Phone:724-772-9833
Practice Address - Fax:724-772-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty