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Organization

SOUTHEAST SPINE CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GEORGE J IVANICKY (OWNER/PRESIDENT)
(225) 753-6333
Entity
Organization

Contact information

Practice address
17431 JEFFERSON HWY, SUITE A, BATON ROUGE, LA 70817-7484
(225) 753-6333
(225) 753-6336
Mailing address
17431 JEFFERSON HWY, SUITE A, BATON ROUGE, LA 70817-7484
(225) 753-6333
(225) 753-6336

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
225100000X
Physical Therapist

Other

Enumeration date
02/14/2012
Last updated
02/14/2012
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