Provider Demographics
NPI:1306079348
Name:SPINAL DC, LLC
Entity type:Organization
Organization Name:SPINAL DC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-695-9355
Mailing Address - Street 1:5309 BUFFALO GAP RD STE B
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-4129
Mailing Address - Country:US
Mailing Address - Phone:325-695-9355
Mailing Address - Fax:325-695-9356
Practice Address - Street 1:5309 BUFFALO GAP RD STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-4129
Practice Address - Country:US
Practice Address - Phone:325-695-9355
Practice Address - Fax:325-695-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11214305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6549680001Medicare NSC