Provider Demographics
NPI:1396967857
Name:NEUROSPINE CENTER
Entity type:Organization
Organization Name:NEUROSPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:RTR-CV
Authorized Official - Phone:704-333-1913
Mailing Address - Street 1:335 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1040
Mailing Address - Country:US
Mailing Address - Phone:704-333-1913
Mailing Address - Fax:704-333-1933
Practice Address - Street 1:335 BILLINGSLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1040
Practice Address - Country:US
Practice Address - Phone:704-333-1913
Practice Address - Fax:704-333-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty