Provider Demographics
NPI:1376680017
Name:SPINE CLINIC INC.
Entity Type:Organization
Organization Name:SPINE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-362-5555
Mailing Address - Street 1:1281 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1959
Mailing Address - Country:US
Mailing Address - Phone:503-362-5555
Mailing Address - Fax:503-362-7250
Practice Address - Street 1:1281 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1959
Practice Address - Country:US
Practice Address - Phone:503-362-5555
Practice Address - Fax:503-362-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOWCKGWMedicare UPIN