Healthcare Provider Details

I. General information

NPI: 1760699326
Provider Name (Legal Business Name): SPINAL & SPORTS CARE CLINIC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-0731
US

IV. Provider business mailing address

12905 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-0731
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-0303
  • Fax: 509-922-0657
Mailing address:
  • Phone: 509-922-0303
  • Fax: 509-922-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. STEVEN L SHIRLEY
Title or Position: CLINIC OWNER
Credential: DC
Phone: 509-922-0303