MEDICARE: MIDWEST SPINE CENTER

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	261Q00000X	Clinic/Center	AO5814	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750412318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST SPINE CENTER

Provider Business Mailing Address
First Line	:	705 N 15TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3344
Country	:	US
Telephone Number	:	515-576-1176
Fax Number	:	515-573-5295

Provider Business Practice Location Address
First Line	:	705 N 15TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3344
Country	:	US
Telephone Number	:	515-576-1176
Fax Number	:	515-573-5295

Authorized Official
Title or Position	:	OWNER
Name	:	BEN ROGERS
Credential	:	D.C.
Telephone Number	:	515-576-1176

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/15/2008

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Directions to “MIDWEST SPINE CENTER ” Practice Location

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