Provider Demographics
NPI:1356885362
Name:VALLEY SPINE AND PAIN LLC
Entity type:Organization
Organization Name:VALLEY SPINE AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-907-2493
Mailing Address - Street 1:PO BOX 18545
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8545
Mailing Address - Country:US
Mailing Address - Phone:256-907-2493
Mailing Address - Fax:256-281-8134
Practice Address - Street 1:2227 DRAKE AVE SW STE 7B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805
Practice Address - Country:US
Practice Address - Phone:256-907-2493
Practice Address - Fax:256-281-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31801208100000X
AL186204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty