Provider Demographics
NPI:1568979961
Name:SPINE AND WELLNESS INSTITUTE, PLLC
Entity Type:Organization
Organization Name:SPINE AND WELLNESS INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-317-4301
Mailing Address - Street 1:5550 WARREN PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7399
Mailing Address - Country:US
Mailing Address - Phone:469-252-4777
Mailing Address - Fax:469-518-2156
Practice Address - Street 1:6300 W PARKER RD STE G25
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8105
Practice Address - Country:US
Practice Address - Phone:469-252-4777
Practice Address - Fax:469-518-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0953261QM1300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain