Healthcare Provider Details

I. General information

NPI: 1053336917
Provider Name (Legal Business Name): SPINAL INTERVENTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 WEST RIVER PARK DR STE 200
PROVO UT
84604-5764
US

IV. Provider business mailing address

280 RIVER PARK DR STE 200
PROVO UT
84604-5793
US

V. Phone/Fax

Practice location:
  • Phone: 801-223-4860
  • Fax: 801-371-8993
Mailing address:
  • Phone: 801-223-4860
  • Fax: 801-371-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number45356
License Number StateUT

VIII. Authorized Official

Name: DANIEL REY FABER
Title or Position: MANAGER
Credential: MD
Phone: 801-380-6239