Provider Demographics
NPI:1114755063
Name:SPINE CENTER
Entity type:Organization
Organization Name:SPINE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-454-1437
Mailing Address - Street 1:5219 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1027
Mailing Address - Country:US
Mailing Address - Phone:314-454-1437
Mailing Address - Fax:314-361-9355
Practice Address - Street 1:5219 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1027
Practice Address - Country:US
Practice Address - Phone:314-454-1437
Practice Address - Fax:314-361-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty