Healthcare Provider Details

I. General information

NPI: 1992274450
Provider Name (Legal Business Name): SPINE & BACK RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 E MAPLE RD
TROY MI
48083-4214
US

IV. Provider business mailing address

1975 E MAPLE RD
TROY MI
48083-4214
US

V. Phone/Fax

Practice location:
  • Phone: 313-550-8087
  • Fax:
Mailing address:
  • Phone: 313-550-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD ABRAHAM
Title or Position: C.E.O
Credential: MD
Phone: 313-550-8087