Provider Demographics
NPI:1780135632
Name:DYNAMIC SPINAL IMAGING OF BATON ROUGE, LLC
Entity type:Organization
Organization Name:DYNAMIC SPINAL IMAGING OF BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:337-244-3590
Mailing Address - Street 1:7922 SUMMA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3475
Mailing Address - Country:US
Mailing Address - Phone:337-244-3590
Mailing Address - Fax:
Practice Address - Street 1:7922 SUMMA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3475
Practice Address - Country:US
Practice Address - Phone:337-244-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain