Provider Demographics
NPI:1316507502
Name:STRUCTURAL SPINAL CARE, LLC
Entity type:Organization
Organization Name:STRUCTURAL SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-397-9083
Mailing Address - Street 1:12251 TAFT ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1915
Mailing Address - Country:US
Mailing Address - Phone:309-397-9083
Mailing Address - Fax:
Practice Address - Street 1:12251 TAFT ST STE 403
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1915
Practice Address - Country:US
Practice Address - Phone:309-397-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty