Provider Demographics
NPI:1427245620
Name:SPINE-D II, LLC
Entity type:Organization
Organization Name:SPINE-D II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARNEST
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-327-8005
Mailing Address - Street 1:515 W FRANCIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6413
Mailing Address - Country:US
Mailing Address - Phone:509-327-8005
Mailing Address - Fax:509-327-7869
Practice Address - Street 1:509 N SULLIVAN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8565
Practice Address - Country:US
Practice Address - Phone:509-327-8005
Practice Address - Fax:509-327-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty