Provider Demographics
NPI:1720403413
Name:BAY AREA SPINE CARE
Entity Type:Organization
Organization Name:BAY AREA SPINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-295-2200
Mailing Address - Street 1:1170 W OLIVE AVE STE B&D
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1959
Mailing Address - Country:US
Mailing Address - Phone:209-276-2200
Mailing Address - Fax:209-276-2202
Practice Address - Street 1:1170 W OLIVE AVE STE B&D
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1959
Practice Address - Country:US
Practice Address - Phone:209-276-2200
Practice Address - Fax:209-276-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76201207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty