Provider Demographics
NPI:1073347696
Name:SPINAL DESTINATION PLC
Entity type:Organization
Organization Name:SPINAL DESTINATION PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-323-1551
Mailing Address - Street 1:3048 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2793
Mailing Address - Country:US
Mailing Address - Phone:563-323-1551
Mailing Address - Fax:563-359-0926
Practice Address - Street 1:3048 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2793
Practice Address - Country:US
Practice Address - Phone:563-323-1551
Practice Address - Fax:563-359-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty