Provider Demographics
NPI:1740873405
Name:SPECIALIZED SPINE CARE, INC.
Entity type:Organization
Organization Name:SPECIALIZED SPINE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:320-253-5385
Mailing Address - Street 1:3333 W DIVISION ST STE 115
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4548
Mailing Address - Country:US
Mailing Address - Phone:320-253-5385
Mailing Address - Fax:320-253-5396
Practice Address - Street 1:3333 W DIVISION ST STE 115
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4548
Practice Address - Country:US
Practice Address - Phone:320-253-5385
Practice Address - Fax:320-253-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty