Provider Demographics
NPI:1912369893
Name:ST CHARLES SPINE INSTITUTE
Entity Type:Organization
Organization Name:ST CHARLES SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:CORWIN
Authorized Official - Last Name:SPAYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-379-2322
Mailing Address - Street 1:558 SAINT CHARLES DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3903
Mailing Address - Country:US
Mailing Address - Phone:805-379-2322
Mailing Address - Fax:805-379-2373
Practice Address - Street 1:558 SAINT CHARLES DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3903
Practice Address - Country:US
Practice Address - Phone:805-379-2322
Practice Address - Fax:805-379-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2023-09-06
Deactivation Date:2023-03-14
Deactivation Code:
Reactivation Date:2023-09-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty