MEDICARE: NUSPINE III INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1396262291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUSPINE III INC.

Provider Business Mailing Address
First Line	:	7241 APPLE VALLEY DR
Second Line	:
City	:	WINDSOR HTS
State	:	IA
Zip	:	50324-1729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7241 APPLE VALLEY DRIVE
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324
Country	:	US
Telephone Number	:	515-225-4706
Fax Number	:

Authorized Official
Title or Position	:	DC
Name	:	TRAVIS JOHN ALGER
Credential	:
Telephone Number	:	515-225-4706

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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