Provider Demographics
NPI:1124060900
Name:THE SPINE CLINIC OF MONTEREY
Entity type:Organization
Organization Name:THE SPINE CLINIC OF MONTEREY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DESTRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SETSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-333-9800
Mailing Address - Street 1:8053 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8053 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4073
Practice Address - Country:US
Practice Address - Phone:831-688-8680
Practice Address - Fax:831-688-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72826332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
5617494OtherOTHER ID NUMBER-COMMERCIAL NUMBER