Provider Demographics
NPI:1841306420
Name:SPOKANE BACK & NECK CLINIC LLC
Entity type:Organization
Organization Name:SPOKANE BACK & NECK CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC, CCSP, CSCS
Authorized Official - Phone:509-468-2102
Mailing Address - Street 1:10003 N DIVISION ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1344
Mailing Address - Country:US
Mailing Address - Phone:509-468-2102
Mailing Address - Fax:509-468-2108
Practice Address - Street 1:10003 N DIVISION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1344
Practice Address - Country:US
Practice Address - Phone:509-468-2102
Practice Address - Fax:509-468-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB28788Medicare ID - Type Unspecified
WAU80999Medicare UPIN