MEDICARE: COLUMBUS SPINE AND SPORT CENTER, LLC

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

General Provider Information

NPI Number	:	1700283090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS SPINE AND SPORT CENTER, LLC

Provider Business Mailing Address
First Line	:	1550 OLD HENDERSON RD
Second Line	:	SUITE E-186
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 OLD HENDERSON RD
Second Line	:	SUITE E-186
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	614-570-0310
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ANNA VOGEL
Credential	:	D.C., M.S.
Telephone Number	:	614-570-0310

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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