Provider Demographics
NPI:1356738645
Name:FIRCREST SPINE CENTER LLC
Entity type:Organization
Organization Name:FIRCREST SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANDZIMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-912-9653
Mailing Address - Street 1:4916 CENTER ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2348
Mailing Address - Country:US
Mailing Address - Phone:253-912-9653
Mailing Address - Fax:253-912-9660
Practice Address - Street 1:4916 CENTER ST
Practice Address - Street 2:SUITE G
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-912-9653
Practice Address - Fax:253-912-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8941449Medicare UPIN