Provider Demographics
NPI:1730575127
Name:PROACTIVE SPINE & JOINT LLC
Entity type:Organization
Organization Name:PROACTIVE SPINE & JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-570-7094
Mailing Address - Street 1:1147 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2061
Mailing Address - Country:US
Mailing Address - Phone:260-927-0581
Mailing Address - Fax:
Practice Address - Street 1:1147 W 15TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2061
Practice Address - Country:US
Practice Address - Phone:260-927-0581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002828A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty