Organization Name: | CENTRAL SPORT AND SPINE LLC |
NPI Number: | 1114352853 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES THORNBURG (SOLE MEMBER) |
Mailing Address: | 160 Sw Scalehouse Loop Suite 140 Bend |
State: | OR US |
Postal Code: | 977021284 |
Phone Number: | 5416179969 |
Fax Number: | 5416179890 |
NPI Enumeration Date: | 09/12/2013 |
NPI Last Update Date: | 01/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 5125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |