Healthcare Provider Details

I. General information

NPI: 1568156545
Provider Name (Legal Business Name): PINNACLE SPINE OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 TECHNOLOGY CENTER DR
ZIONSVILLE IN
46077
US

IV. Provider business mailing address

6300 TECHNOLOGY CENTER DR
ZIONSVILLE IN
46077
US

V. Phone/Fax

Practice location:
  • Phone: 630-794-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SIROIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 630-794-9999