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General NPI Number Information
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NPI Number | 1255602181
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC SPINAL ANALYSIS LLC
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 6699 WESTLAKE RD
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City | NEWBURGH
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State | IN
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Zip | 47630-2029
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Country | US
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Telephone | 812-480-1462
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Fax |
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Provider Business Mailing Address
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Address Line | 6699 WESTLAKE RD
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City | NEWBURGH
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State | IN
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Zip | 47630-2029
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Country | US
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Telephone | 812-480-1462
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAUN TYMCHAK
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Credential | DC
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Telephone | 812-480-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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