Provider Demographics
NPI:1760604409
Name:SPINEONE, PLLC
Entity Type:Organization
Organization Name:SPINEONE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-367-2225
Mailing Address - Street 1:8500 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-367-2225
Mailing Address - Fax:303-343-8702
Practice Address - Street 1:8500 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-367-2225
Practice Address - Fax:303-343-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32744174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804191Medicare UPIN
COF49572Medicare UPIN