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General NPI Number Information
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NPI Number | 1538240189
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Entity Type | Organization
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Legal Business Name | SPINE ALIGN CHIROPRACTIC CENTER, PA
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 3750 EVANS ST STE. C
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City | GREENVILLE
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State | NC
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Zip | 27834-5412
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Country | US
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Telephone | 252-355-1770
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Fax | 252-353-1415
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Provider Business Mailing Address
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Address Line | 3750 EVANS ST STE. C
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City | GREENVILLE
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State | NC
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Zip | 27834-5412
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Country | US
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Telephone | 252-355-1770
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Fax | 252-353-1415
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. LISA D PRUSINSKI
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Credential | D.C.
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Telephone | 252-355-1770
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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 |
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License Number State |
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