| NPI | 1265644397 |
|---|---|
| Former Legal Business Name | INDIANA LASER SPINE CENTER INC |
| Entity Type | Organization |
| Authorized Contact | PHILLIP R. KINGMA Owner/Physician 317-577-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IN 01040487A) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: IN 01040487) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-02-08 |