Provider Demographics
NPI:1558725994
Name:SKYE SPINE & PAIN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SKYE SPINE & PAIN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-726-0136
Mailing Address - Street 1:1314 W AVENUE J STE A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2936
Mailing Address - Country:US
Mailing Address - Phone:661-726-0136
Mailing Address - Fax:
Practice Address - Street 1:1314 W AVENUE J STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2936
Practice Address - Country:US
Practice Address - Phone:661-726-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty