Healthcare Provider Details

I. General information

NPI: 1457752040
Provider Name (Legal Business Name): WESTERVILLE SPINE & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 PARK MEADOW ROAD SUITE E
WESTERVILLE OH
43081
US

IV. Provider business mailing address

623 PARK MEADOW ROAD SUITE E
WESTERVILLE OH
43081
US

V. Phone/Fax

Practice location:
  • Phone: 614-384-0800
  • Fax: 614-384-0801
Mailing address:
  • Phone: 614-384-0800
  • Fax: 614-384-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number StateOH

VIII. Authorized Official

Name: ROBERT BROOKS
Title or Position: OWNER
Credential:
Phone: 614-384-0800