Provider Demographics
NPI:1962926147
Name:SPINE RESTORATION A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SPINE RESTORATION A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:818-981-2288
Mailing Address - Street 1:16030 VENTURA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2778
Mailing Address - Country:US
Mailing Address - Phone:818-981-2288
Mailing Address - Fax:818-981-2389
Practice Address - Street 1:16030 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2778
Practice Address - Country:US
Practice Address - Phone:818-981-2288
Practice Address - Fax:818-981-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71795261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty