Healthcare Provider Details

I. General information

NPI: 1568596732
Provider Name (Legal Business Name): SPINAL IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NORFOLK AVE
SOUTH EASTON MA
02375-1157
US

IV. Provider business mailing address

5 NORFOLK AVE PO BOX 1200
SOUTH EASTON MA
02375-1157
US

V. Phone/Fax

Practice location:
  • Phone: 508-238-0600
  • Fax: 508-238-0786
Mailing address:
  • Phone: 508-238-0600
  • Fax: 508-238-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH2416
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCE004979
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: LYNN M MANDEVILLE
Title or Position: TEAM LEADER
Credential:
Phone: 508-238-0600