Provider Demographics
NPI:1629346598
Name:SPINEDOC LLC
Entity Type:Organization
Organization Name:SPINEDOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-435-6533
Mailing Address - Street 1:2403 UTICA LN
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5850
Mailing Address - Country:US
Mailing Address - Phone:806-435-6533
Mailing Address - Fax:806-435-2669
Practice Address - Street 1:2400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5223
Practice Address - Country:US
Practice Address - Phone:806-435-6533
Practice Address - Fax:806-435-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1165Medicare UPIN