Healthcare Provider Details

I. General information

NPI: 1689872152
Provider Name (Legal Business Name): SPINE & MUSCULOSKELETAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E COLUMBUS DRIVE SUITE B
EAST CHICAGO IN
46312-3078
US

IV. Provider business mailing address

9430 WICKER AVE
SAINT JOHN IN
46373-9768
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-8648
  • Fax: 219-397-8653
Mailing address:
  • Phone: 219-558-8068
  • Fax: 219-558-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2001917
License Number StateIN

VIII. Authorized Official

Name: DR. JOSEPH P SPOTT
Title or Position: OWNER
Credential: DO
Phone: 219-397-8648