Provider Demographics
NPI:1427286814
Name:SPINE AND JOINT INSTITUTE OF RACINE, INC
Entity type:Organization
Organization Name:SPINE AND JOINT INSTITUTE OF RACINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-898-9000
Mailing Address - Street 1:6211 DURAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4956
Mailing Address - Country:US
Mailing Address - Phone:262-898-9000
Mailing Address - Fax:
Practice Address - Street 1:6211 DURAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4956
Practice Address - Country:US
Practice Address - Phone:262-898-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4264-012111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty