Provider Demographics
NPI:1972896793
Name:SPERO PAIN RELIEF THERAPY, LLC
Entity Type:Organization
Organization Name:SPERO PAIN RELIEF THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:CHALMERS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-1916
Mailing Address - Street 1:PO BOX 2696
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-2696
Mailing Address - Country:US
Mailing Address - Phone:435-656-1916
Mailing Address - Fax:435-656-0444
Practice Address - Street 1:249 E TABERNACLE ST STE 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2995
Practice Address - Country:US
Practice Address - Phone:435-656-1916
Practice Address - Fax:435-656-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3541777-4405261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain