Provider Demographics
NPI:1093345217
Name:SPINE DOCTORS OF MICHIGAN P.C
Entity Type:Organization
Organization Name:SPINE DOCTORS OF MICHIGAN P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:THABO
Authorized Official - Last Name:DIATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-968-9355
Mailing Address - Street 1:2 MICHIGAN AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3621
Mailing Address - Country:US
Mailing Address - Phone:269-968-9355
Mailing Address - Fax:269-968-9366
Practice Address - Street 1:2 MICHIGAN AVE W STE 200
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3621
Practice Address - Country:US
Practice Address - Phone:269-968-9355
Practice Address - Fax:269-968-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty