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General NPI Number Information
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NPI Number | 1366715252
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Entity Type | Organization
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Legal Business Name | DYNAMIC SPINE AND REHABILITATION CENTER
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 106 E PICKWICK DR
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City | SYRACUSE
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State | IN
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Zip | 46567-1713
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Country | US
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Telephone | 574-457-7472
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Fax | 574-457-7103
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | SYRACUSE
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State | IN
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Zip | 46567-0091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERICK LEFFLER
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Credential | DC
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Telephone | 574-457-7472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002928A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002619A
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License Number State | IN
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