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General NPI Number Information
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NPI Number | 1073727277
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Entity Type | Organization
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Legal Business Name | SPINE & BRAIN GROUP SC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 505 S 24TH AVE STE 200
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City | WAUSAU
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State | WI
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Zip | 54401-1706
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Country | US
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Telephone | 715-396-3191
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Fax | 715-396-3191
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Provider Business Mailing Address
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Address Line | 505 S 24TH AVE STE 200
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City | WAUSAU
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State | WI
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Zip | 54401-1706
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Country | US
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Telephone | 715-396-3191
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Fax | 715-396-3191
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER I MACKAY
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Credential | M.D.
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Telephone | 715-396-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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