MEDICARE: SPINE ALIGN CHIROPRACTIC CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0210U	OTHER	NC	BLUECROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538240189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE ALIGN CHIROPRACTIC CENTER, PA

Provider Business Mailing Address
First Line	:	3750 EVANS ST
Second Line	:	STE. C
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5412
Country	:	US
Telephone Number	:	252-355-1770
Fax Number	:	252-353-1415

Provider Business Practice Location Address
First Line	:	3750 EVANS ST
Second Line	:	STE. C
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5412
Country	:	US
Telephone Number	:	252-355-1770
Fax Number	:	252-353-1415

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. LISA D PRUSINSKI
Credential	:	D.C.
Telephone Number	:	252-355-1770

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	10/10/2011

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