Provider Demographics
NPI:1356471593
Name:SPINE, JOHN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SPINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:720 AUSTIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2422
Mailing Address - Country:US
Mailing Address - Phone:303-828-9355
Mailing Address - Fax:303-828-4883
Practice Address - Street 1:720 AUSTIN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2422
Practice Address - Country:US
Practice Address - Phone:303-828-9355
Practice Address - Fax:303-828-4883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65560Medicare UPIN
COC486058Medicare PIN
486058Medicare ID - Type Unspecified