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General NPI Number Information
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NPI Number | 1750759684
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Entity Type | Organization
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Legal Business Name | CRV SPORT AND SPINE
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 103 HANOVER ST STE 17
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City | LEBANON
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State | NH
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Zip | 03766-1098
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Country | US
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Telephone | 603-727-9726
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Fax | 603-727-9746
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Provider Business Mailing Address
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Address Line | 103 HANOVER ST STE 17
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City | LEBANON
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State | NH
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Zip | 03766-1098
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Country | US
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Telephone | 603-727-9726
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Fax | 603-727-9746
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JON STUART NYE
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Credential | D.C.
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Telephone | 603-727-9726
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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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