Provider Demographics
NPI:1316295884
Name:MJJD SPINE GROUP, LTD
Entity type:Organization
Organization Name:MJJD SPINE GROUP, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-644-6724
Mailing Address - Street 1:2322 E 22ND ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:855-644-6724
Mailing Address - Fax:
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:855-644-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2901111NR0400X
OH1473111NR0400X
OH3343111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty