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General NPI Number Information
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NPI Number | 1780135632
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Entity Type | Organization
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Legal Business Name | DYNAMIC SPINAL IMAGING OF BATON ROUGE, LLC
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Dates
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Enumeration Date | 10/16/2016
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Last Update Date | 10/16/2016
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Provider Practice Location Address
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Address Line | 7922 SUMMA AVE SUITE 4
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City | BATON ROUGE
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State | LA
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Zip | 70809-3475
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Country | US
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Telephone | 337-244-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 7922 SUMMA AVE SUITE 4
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City | BATON ROUGE
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State | LA
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Zip | 70809-3475
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Country | US
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Telephone | 337-244-3590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CONDOS
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Credential | PHD
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Telephone | 337-244-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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