Provider Demographics
NPI:1932328556
Name:SPINE & JOINT PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:SPINE & JOINT PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-935-2700
Mailing Address - Street 1:202 S. ALAMO
Mailing Address - Street 2:SUITE I
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670
Mailing Address - Country:US
Mailing Address - Phone:903-935-2700
Mailing Address - Fax:903-935-2751
Practice Address - Street 1:202 S. ALAMO
Practice Address - Street 2:SUITE I
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670
Practice Address - Country:US
Practice Address - Phone:903-935-2700
Practice Address - Fax:903-935-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2582111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty