MEDICARE: QUEEN CITY SPINE & REHAB INC

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	3792	OH

General Provider Information

NPI Number	:	1710209796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY SPINE & REHAB INC

Provider Business Mailing Address
First Line	:	3557 SPRINGDALE RD
Second Line	:	SUITE B
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3557 SPRINGDALE RD
Second Line	:	SUITE B
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1314
Country	:	US
Telephone Number	:	513-335-8443
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN HUEY
Credential	:	D.C.
Telephone Number	:	513-608-1636

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	04/28/2010

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Directions to “QUEEN CITY SPINE & REHAB INC ” Practice Location

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