Provider Demographics
NPI:1144367046
Name:MUNCY SPINAL INSTITUTE LLC
Entity type:Organization
Organization Name:MUNCY SPINAL INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-591-5448
Mailing Address - Street 1:300 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4495
Mailing Address - Country:US
Mailing Address - Phone:276-591-5448
Mailing Address - Fax:276-591-5447
Practice Address - Street 1:300 MOORE ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4337
Practice Address - Country:US
Practice Address - Phone:276-591-5448
Practice Address - Fax:276-591-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00311241OtherRAILROAD MEDICARE
VA010133807Medicaid
VA146646OtherBLUE CROSS BLUE SHIELD