Provider Demographics
NPI:1104136324
Name:SPINA, NICK
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:SPINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3549
Mailing Address - Country:US
Mailing Address - Phone:205-755-8501
Mailing Address - Fax:
Practice Address - Street 1:606 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3549
Practice Address - Country:US
Practice Address - Phone:205-755-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4128237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20-2249708OtherTAX ID NUMBER 20-2249708