Provider Demographics
NPI:1518167923
Name:SPOKANE SPINE CENTER PC
Entity Type:Organization
Organization Name:SPOKANE SPINE CENTER PC
Other - Org Name:SPOKANE SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-487-6222
Mailing Address - Street 1:124 E ROWAN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1214
Mailing Address - Country:US
Mailing Address - Phone:509-487-6222
Mailing Address - Fax:509-487-6333
Practice Address - Street 1:124 E ROWAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-6222
Practice Address - Fax:509-487-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858135Medicare PIN
WAU89731Medicare UPIN