Provider Demographics
NPI:1548096001
Name:VALOR SPINE SOLUTIONS
Entity type:Organization
Organization Name:VALOR SPINE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-901-3369
Mailing Address - Street 1:825 S WAUKEGAN RD STE A8252
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2696
Mailing Address - Country:US
Mailing Address - Phone:435-901-3369
Mailing Address - Fax:
Practice Address - Street 1:6800 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3819
Practice Address - Country:US
Practice Address - Phone:435-901-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain