Provider Demographics
NPI:1558311746
Name:SWEETWATER SPINE CLINIC, P.A.
Entity Type:Organization
Organization Name:SWEETWATER SPINE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-235-9355
Mailing Address - Street 1:1413 HAILEY ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-2507
Mailing Address - Country:US
Mailing Address - Phone:325-235-9355
Mailing Address - Fax:325-235-1011
Practice Address - Street 1:1413 HAILEY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-2507
Practice Address - Country:US
Practice Address - Phone:325-235-9355
Practice Address - Fax:325-235-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00884XMedicare ID - Type UnspecifiedGRP#