Provider Demographics
NPI:1073969960
Name:SPINE BY DESIGN INC.
Entity Type:Organization
Organization Name:SPINE BY DESIGN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-972-1144
Mailing Address - Street 1:10032 BUCHANAN RD
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49346
Mailing Address - Country:US
Mailing Address - Phone:231-972-1144
Mailing Address - Fax:888-965-4351
Practice Address - Street 1:10032 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:MI
Practice Address - Zip Code:49346
Practice Address - Country:US
Practice Address - Phone:231-972-1144
Practice Address - Fax:888-965-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174728315OtherNPI
11493612OtherCAQH ID
MIMI9379OtherMEDICARE ID
MI2301009783OtherMICHIGAN CHIROPRACTIC LICENSE