Provider Demographics
NPI:1891748323
Name:SPOKANE SPORTS AND SPINE PLLC
Entity Type:Organization
Organization Name:SPOKANE SPORTS AND SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-242-6005
Mailing Address - Street 1:507 S WASHINGTON ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 S WASHINGTON ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2604
Practice Address - Country:US
Practice Address - Phone:509-242-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty