Provider Demographics
NPI:1841731627
Name:SPINE BY DESIGN INC
Entity type:Organization
Organization Name:SPINE BY DESIGN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-226-1932
Mailing Address - Street 1:60 WESTERN AVE
Mailing Address - Street 2:STE 3-234
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6338
Mailing Address - Country:US
Mailing Address - Phone:207-226-1932
Mailing Address - Fax:888-965-5221
Practice Address - Street 1:60 WESTERN AVE
Practice Address - Street 2:STE 3-234
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6338
Practice Address - Country:US
Practice Address - Phone:207-226-1932
Practice Address - Fax:888-965-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174728315OtherNPI
MECR1543OtherMAINE CHIROPRACTIC LICENSE
MEMM807301Medicare PIN