Provider Demographics
NPI:1891835054
Name:SPINA, MARY ANN J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:J
Last Name:SPINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3029
Mailing Address - Country:US
Mailing Address - Phone:973-636-6144
Mailing Address - Fax:973-636-6144
Practice Address - Street 1:183 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-3029
Practice Address - Country:US
Practice Address - Phone:973-636-6144
Practice Address - Fax:973-636-6144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00506700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU66100Medicare UPIN
NJSP900892Medicare ID - Type Unspecified