Provider Demographics
NPI:1649340522
Name:LONGMONT SPINE CENTER INC
Entity type:Organization
Organization Name:LONGMONT SPINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-219-8622
Mailing Address - Street 1:2144 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8402
Mailing Address - Country:US
Mailing Address - Phone:303-678-7170
Mailing Address - Fax:303-678-7134
Practice Address - Street 1:2144 MAIN ST.
Practice Address - Street 2:UNIT 3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-678-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty