Healthcare Provider Details

I. General information

NPI: 1003901778
Provider Name (Legal Business Name): SPECTRUM INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WASHINGTON STREET, SUITE 1
DECORAH IA
52101-2240
US

IV. Provider business mailing address

607 WASHINGTON STREET, SUITE 1
DECORAH IA
52101-2240
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-8401
  • Fax: 563-382-8403
Mailing address:
  • Phone: 563-382-8401
  • Fax: 563-382-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MICHAEL MICULINICH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-382-8401