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Organization
INSTITUTE FOR LOW BACK CARE LLC
Active
Organization
INSTITUTE FOR LOW BACK CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANJINI M. SIVANNA MD (PRESIDENT)
(701) 297-0817
Entity
Organization
Contact information
Practice address
300 MAIN AVE, SUITE 212, FARGO, ND 58103-1930
(701) 297-0817
(701) 297-6870
Mailing address
300 MAIN AVE, SUITE 212, FARGO, ND 58103-1930
(701) 297-0817
(701) 297-6870
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4806
ND
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
4806
ND
261QP3300X
Pain Clinic/Center
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6826334
—
ND
Enumeration date
09/20/2006
Last updated
05/07/2013
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