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General NPI Number Information
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NPI Number | 1447479571
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC SPINE CENTER, LLC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 1930 PEARL RD SUITE 2
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City | BRUNSWICK
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State | OH
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Zip | 44212-6477
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Country | US
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Telephone | 330-220-2001
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Fax | 330-220-2232
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Provider Business Mailing Address
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Address Line | 1930 PEARL RD SUITE 2
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City | BRUNSWICK
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State | OH
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Zip | 44212-6477
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Country | US
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Telephone | 330-220-2001
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Fax | 330-220-2232
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Authorized Official
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Title or Position | MANAGER/BILLER
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Name | MRS. DANY/LAURA CAMBOURIS/DEW
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Credential |
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Telephone | 330-220-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3400
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License Number State | OH
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