Provider Demographics
NPI:1205806312
Name:SPINELLI, CHRISTOPHER R (DO)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:R
Last Name:SPINELLI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1000 E PRIMROSE ST STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-1010
Practice Address - Fax:417-269-6755
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001008550208000000X
IA3898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207613803Medicaid
IA1205806312Medicaid
IA1205806312Medicaid
MO1205806312Medicaid