Provider Demographics
NPI:1760699326
Name:SPINAL & SPORTS CARE CLINIC P S
Entity Type:Organization
Organization Name:SPINAL & SPORTS CARE CLINIC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-922-0303
Mailing Address - Street 1:12905 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0731
Mailing Address - Country:US
Mailing Address - Phone:509-922-0303
Mailing Address - Fax:509-922-0657
Practice Address - Street 1:12905 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0731
Practice Address - Country:US
Practice Address - Phone:509-922-0303
Practice Address - Fax:509-922-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0038870OtherLABOR AND INDUSTRIES
WA0038870OtherLABOR AND INDUSTRIES