Provider Demographics
NPI:1235511833
Name:AMERICAN SPINE PC
Entity Type:Organization
Organization Name:AMERICAN SPINE PC
Other - Org Name:AMERICAN SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHURAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-7246
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:31565 RANCHO PUEBLO RD
Practice Address - Street 2:SUITE #102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4838
Practice Address - Country:US
Practice Address - Phone:951-734-7246
Practice Address - Fax:877-694-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty