Provider Demographics
NPI:1861779977
Name:POSTURE AND SPINE CARE CENTER SC
Entity type:Organization
Organization Name:POSTURE AND SPINE CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOVORANY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-437-3370
Mailing Address - Street 1:2031 S WEBSTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2257
Mailing Address - Country:US
Mailing Address - Phone:920-437-3370
Mailing Address - Fax:920-437-6212
Practice Address - Street 1:2031 S WEBSTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2257
Practice Address - Country:US
Practice Address - Phone:920-437-3370
Practice Address - Fax:920-437-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3416111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty