Provider Demographics
NPI:1427284983
Name:SPINE & ORTHOPEDIC MEDICINE, INC
Entity type:Organization
Organization Name:SPINE & ORTHOPEDIC MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:574-255-7246
Mailing Address - Street 1:51050 BITTERSWEET RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7879
Mailing Address - Country:US
Mailing Address - Phone:574-255-7246
Mailing Address - Fax:574-243-9060
Practice Address - Street 1:51050 BITTERSWEET RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7879
Practice Address - Country:US
Practice Address - Phone:574-255-7246
Practice Address - Fax:574-243-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001668A204D00000X
ININ02001668A208VP0014X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING16169Medicare UPIN
IN262690AMedicare PIN