Provider Demographics
NPI:1770797227
Name:SPINE CENTER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SPINE CENTER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-544-5202
Mailing Address - Street 1:107 N WILSON DR
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1560
Mailing Address - Country:US
Mailing Address - Phone:937-544-5202
Mailing Address - Fax:937-544-8148
Practice Address - Street 1:107 N WILSON DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1560
Practice Address - Country:US
Practice Address - Phone:937-544-5202
Practice Address - Fax:937-544-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1770797227OtherGROUP NPI
OH2296000Medicaid
OH2296000Medicaid