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General NPI Number Information
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NPI Number | 1609264795
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Entity Type | Organization
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Legal Business Name | SPINE AND JOINT ASSOCIATES OF MISHAWAKA, INC
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 229 RED COACH TRAIL SUITE 106
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-386-2451
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Fax |
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Provider Business Mailing Address
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Address Line | 229 RED COACH TRAIL SUITE 106
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-386-2451
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CARRIE ANN PINTO
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Credential |
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Telephone | 574-386-2451
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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 | 08001788A
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License Number State | IN
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