Provider Demographics
NPI:1134414584
Name:ASSOCIATES IN SPINE AND JOINT MEDICINE, LLC
Entity type:Organization
Organization Name:ASSOCIATES IN SPINE AND JOINT MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-476-4751
Mailing Address - Street 1:3372 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3718
Mailing Address - Country:US
Mailing Address - Phone:423-476-4751
Mailing Address - Fax:423-339-2692
Practice Address - Street 1:3372 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3718
Practice Address - Country:US
Practice Address - Phone:423-476-4751
Practice Address - Fax:423-339-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363L00000X
207Q00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6656260001OtherMEDICARE PTAN