Provider Demographics
NPI:1881068427
Name:ADVANCED SPINE JOINT AND WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCED SPINE JOINT AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFTZGER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:330-721-6504
Mailing Address - Street 1:3591 RESERVE COMMONS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5334
Mailing Address - Country:US
Mailing Address - Phone:330-721-6504
Mailing Address - Fax:330-721-6508
Practice Address - Street 1:3591 RESERVE COMMONS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5334
Practice Address - Country:US
Practice Address - Phone:330-721-6504
Practice Address - Fax:330-721-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085605Medicaid
OH7411320001Medicare NSC
OH0085605Medicaid