Provider Demographics
NPI:1558759654
Name:SPINE AND JOINT ASSOCIATES OF PLYMOUTH, INC
Entity Type:Organization
Organization Name:SPINE AND JOINT ASSOCIATES OF PLYMOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-386-2451
Mailing Address - Street 1:2899 MILLER DRIVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563
Mailing Address - Country:US
Mailing Address - Phone:574-386-2451
Mailing Address - Fax:
Practice Address - Street 1:229 RED COACH
Practice Address - Street 2:SUITE 106
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-386-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001788A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty