OrganizationActive
Institute for Low Back Care LLC
NPI 1124125109 · Ambulatory Surgical Clinic/Center · Fargo, ND
Provider details
- NPI number
- 1124125109
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Panjini Sivanna, President(701) 297-0817
- License
- 4806 (ND)
Specialties & taxonomies
Ambulatory Health Care Facilities
Other Service Providers
- Pain Clinic/Center261QP3300X
Ambulatory Health Care Facilities
Practice location
300 Main Ave
Suite 212
Fargo, ND 58103-1930
Phone: (701) 297-0817
Fax: (701) 297-6870
Approximate (ZIP-level) locationGet directions
Mailing address
300 Main Ave
Fargo, ND 58103-1930
Registry dates
- Enumerated
- 2006-09-20
- Last updated
- 2013-05-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.