Provider Demographics
NPI:1558436865
Name:SPINE CLINIC OF MONTEREY BAY
Entity Type:Organization
Organization Name:SPINE CLINIC OF MONTEREY BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-465-8680
Mailing Address - Street 1:3035 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2204
Mailing Address - Country:US
Mailing Address - Phone:831-465-8680
Mailing Address - Fax:831-465-8682
Practice Address - Street 1:3035 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2204
Practice Address - Country:US
Practice Address - Phone:831-465-8680
Practice Address - Fax:831-465-8682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SPINE CLINIC OF MENTEREY BAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52067207Q00000X
CAA72826207XS0117X
CA20A8078207XS0117X
CA20A7926208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty