Healthcare Provider Details

I. General information

NPI: 1104539774
Provider Name (Legal Business Name): INSPIRED SPINE HEALTH OF KS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E 23RD AVE
HUTCHINSON KS
67502-1106
US

IV. Provider business mailing address

1601 HIGHWAY 13 E STE 100
BURNSVILLE MN
55337-6847
US

V. Phone/Fax

Practice location:
  • Phone: 952-405-9760
  • Fax: 855-430-6952
Mailing address:
  • Phone: 952-405-9760
  • Fax: 855-430-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE NAVARRETE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 651-456-8795