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General NPI Number Information
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NPI Number | 1306079348
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Entity Type | Organization
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Legal Business Name | SPINAL DC, LLC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 5309 BUFFALO GAP RD STE B
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City | ABILENE
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State | TX
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Zip | 79606-4129
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Country | US
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Telephone | 325-695-9355
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Fax | 325-695-9356
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Provider Business Mailing Address
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Address Line | 5309 BUFFALO GAP RD STE B
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City | ABILENE
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State | TX
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Zip | 79606-4129
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Country | US
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Telephone | 325-695-9355
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Fax | 325-695-9356
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAKE ALAN MORGAN
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Credential | D.C.
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Telephone | 325-695-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 11214
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License Number State | TX
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