Provider Demographics
NPI:1568906030
Name:NEW SPINE
Entity Type:Organization
Organization Name:NEW SPINE
Other - Org Name:RIVERSIDE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-424-6104
Mailing Address - Street 1:2118 RIVERSIDE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5454
Mailing Address - Country:US
Mailing Address - Phone:360-424-6104
Mailing Address - Fax:
Practice Address - Street 1:2118 RIVERSIDE DR STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5454
Practice Address - Country:US
Practice Address - Phone:360-424-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60562639261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty