Provider Demographics
NPI:1336428424
Name:LIVING SPINAL LLC
Entity Type:Organization
Organization Name:LIVING SPINAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-475-1966
Mailing Address - Street 1:7340 TRADE ST
Mailing Address - Street 2:STE F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2457
Mailing Address - Country:US
Mailing Address - Phone:619-810-0010
Mailing Address - Fax:619-752-2005
Practice Address - Street 1:7340 TRADE ST
Practice Address - Street 2:STE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2457
Practice Address - Country:US
Practice Address - Phone:619-810-0010
Practice Address - Fax:619-752-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4452540Medicaid
CA6750100001Medicare NSC