Provider Demographics
NPI:1538240189
Name:SPINE ALIGN CHIROPRACTIC CENTER, PA
Entity type:Organization
Organization Name:SPINE ALIGN CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRUSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-355-1770
Mailing Address - Street 1:3750 EVANS ST
Mailing Address - Street 2:STE. C
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5412
Mailing Address - Country:US
Mailing Address - Phone:252-355-1770
Mailing Address - Fax:252-353-1415
Practice Address - Street 1:3750 EVANS ST
Practice Address - Street 2:STE. C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5412
Practice Address - Country:US
Practice Address - Phone:252-355-1770
Practice Address - Fax:252-353-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0210UOtherBLUECROSS/BLUE SHIELD
NC890210UMedicaid
NC2451543Medicare PIN