Provider Demographics
NPI:1083994958
Name:NON SURGICAL SPINE & JOINT CLINIC PS
Entity Type:Organization
Organization Name:NON SURGICAL SPINE & JOINT CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-200-5826
Mailing Address - Street 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 219
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-200-5826
Mailing Address - Fax:360-200-5833
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 219
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
Practice Address - Country:US
Practice Address - Phone:360-200-5826
Practice Address - Fax:360-200-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Single Specialty