Provider Demographics
NPI:1366734246
Name:SPINAL HEALTH INSTITUTE
Entity type:Organization
Organization Name:SPINAL HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:HARCOURT
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-988-7800
Mailing Address - Street 1:6040 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4539
Mailing Address - Country:US
Mailing Address - Phone:916-988-7800
Mailing Address - Fax:916-988-7811
Practice Address - Street 1:6040 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4539
Practice Address - Country:US
Practice Address - Phone:916-988-7800
Practice Address - Fax:916-988-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33878232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty