Healthcare Provider Details

I. General information

NPI: 1346567518
Provider Name (Legal Business Name): SPINE & JOINT CENTER OF SOUTHWEST INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S MERIDIAN ST SUITE A
WASHINGTON IN
47501-4228
US

IV. Provider business mailing address

1211 S MERIDIAN ST SUITE A
WASHINGTON IN
47501-4228
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2203
  • Fax: 812-254-2033
Mailing address:
  • Phone: 812-254-2203
  • Fax: 812-254-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002488A
License Number StateIN

VIII. Authorized Official

Name: DR. JESS THOMAS BROWER
Title or Position: OWNER
Credential: D.C.
Phone: 812-486-6294