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General NPI Number Information
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NPI Number | 1598986812
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Entity Type | Organization
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Legal Business Name | SPINE CENTER II, INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 4546 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40220-3528
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Country | US
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Telephone | 502-493-1040
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Fax | 502-493-4754
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Provider Business Mailing Address
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Address Line | 4546 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40220-3528
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Country | US
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Telephone | 502-493-1040
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Fax | 502-493-4754
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Authorized Official
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Title or Position | OWNER
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Name | TODD M HOSTUTLER
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Credential |
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Telephone | 502-231-4003
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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 | 4532
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License Number State | KY
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