Provider Demographics
NPI:1811017544
Name:THE ARCADIA SPINE CENTER INC
Entity Type:Organization
Organization Name:THE ARCADIA SPINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:CLARIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-447-0447
Mailing Address - Street 1:638 W DUARTE RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7616
Mailing Address - Country:US
Mailing Address - Phone:626-447-0447
Mailing Address - Fax:626-447-0324
Practice Address - Street 1:638 W DUARTE RD
Practice Address - Street 2:SUITE 16
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7616
Practice Address - Country:US
Practice Address - Phone:626-447-0447
Practice Address - Fax:626-447-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25049111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04897Medicare UPIN
DC25049Medicare PIN