Provider Demographics
NPI:1841672433
Name:PRO SPORT AND SPINE PLLC
Entity type:Organization
Organization Name:PRO SPORT AND SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-853-4000
Mailing Address - Street 1:5160 BORGEN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8809
Mailing Address - Country:US
Mailing Address - Phone:253-853-4000
Mailing Address - Fax:
Practice Address - Street 1:5160 BORGEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8809
Practice Address - Country:US
Practice Address - Phone:253-853-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60071160111NR0400X
WACH60066715111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty