Provider Demographics
NPI:1669097838
Name:PRECISION SPINE AND JOINT LLC
Entity type:Organization
Organization Name:PRECISION SPINE AND JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENEANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-263-1642
Mailing Address - Street 1:312 JACKSON WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5913
Mailing Address - Country:US
Mailing Address - Phone:772-546-9591
Mailing Address - Fax:
Practice Address - Street 1:130 TIBET AVE APT 202
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-9030
Practice Address - Country:US
Practice Address - Phone:772-546-9591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty