Provider Demographics
NPI:1184843245
Name:GSA PLANO
Entity Type:Organization
Organization Name:GSA PLANO
Other - Org Name:GENESIS SPINE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-378-9991
Mailing Address - Street 1:6101 WINDCOM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7895
Mailing Address - Country:US
Mailing Address - Phone:972-378-9991
Mailing Address - Fax:972-378-9992
Practice Address - Street 1:6101 WINDCOM CT
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7895
Practice Address - Country:US
Practice Address - Phone:972-378-9991
Practice Address - Fax:972-378-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty