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General NPI Number Information
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NPI Number | 1992546279
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Entity Type | Organization
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Legal Business Name | DYNAMIC SPINE AND SPORTS PERFORMANCE LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 3806 COUNTRY CLUB LN STE B
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City | KEARNEY
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State | NE
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Zip | 68845-4134
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Country | US
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Telephone | 308-440-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 3806 COUNTRY CLUB LN STE B
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City | KEARNEY
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State | NE
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Zip | 68845-4134
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Country | US
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Telephone | 308-440-2149
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JACOB BENJAMIN BARTLING
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Credential | DC
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Telephone | 308-440-2149
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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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