Provider Demographics
NPI:1023860129
Name:BRODWYN SPINE CENTER LLC
Entity type:Organization
Organization Name:BRODWYN SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-710-0327
Mailing Address - Street 1:8132 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1801
Mailing Address - Country:US
Mailing Address - Phone:770-710-0327
Mailing Address - Fax:770-695-0348
Practice Address - Street 1:8132 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1801
Practice Address - Country:US
Practice Address - Phone:770-710-0327
Practice Address - Fax:770-695-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty