Provider Demographics
NPI:1336505551
Name:HASTINGS SPORT AND SPINE LLC
Entity type:Organization
Organization Name:HASTINGS SPORT AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-409-2056
Mailing Address - Street 1:1806 VERMILLION ST STE A
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3605
Mailing Address - Country:US
Mailing Address - Phone:510-409-2056
Mailing Address - Fax:651-382-1661
Practice Address - Street 1:1806 VERMILLION ST STE A
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3605
Practice Address - Country:US
Practice Address - Phone:563-449-6651
Practice Address - Fax:651-382-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty