Provider Demographics
NPI:1306045901
Name:SPINAL DECOMPRESSION INC
Entity Type:Organization
Organization Name:SPINAL DECOMPRESSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-536-2304
Mailing Address - Street 1:16223 BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4777
Mailing Address - Country:US
Mailing Address - Phone:636-536-2304
Mailing Address - Fax:
Practice Address - Street 1:16223 BAXTER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4777
Practice Address - Country:US
Practice Address - Phone:636-536-2304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005552111N00000X
332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000026201Medicare PIN
5985410001Medicare NSC