Provider Demographics
NPI:1831890789
Name:SOUTHEAST SPINE AND PAIN ASSOCIATES INC.
Entity type:Organization
Organization Name:SOUTHEAST SPINE AND PAIN ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-257-9911
Mailing Address - Street 1:PO BOX 27629
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37927-7629
Mailing Address - Country:US
Mailing Address - Phone:865-307-7323
Mailing Address - Fax:
Practice Address - Street 1:4713 PAPERMILL DR STE 301
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1908
Practice Address - Country:US
Practice Address - Phone:865-307-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty