Organization
MIDWEST SPINE INTERVENTIONALIST,LLC
Active
Other names
INTERVENTIONAL SPINE & PAIN CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVEKANAND MANOCHA MD (OWNER)
(937) 619-0724
Entity
Organization
Contact information
Practice address
578 N MAIN ST, SPRINGBORO, OH 45066-9552
(937) 619-0724
(937) 619-0400
Mailing address
578 N MAIN ST, SPRINGBORO, OH 45066-9552
(937) 619-0724
(937) 619-0400
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
35-087792
OH
Other
Enumeration date
03/28/2007
Last updated
10/01/2021
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