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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