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General NPI Number Information
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NPI Number | 1689872152
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Entity Type | Organization
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Legal Business Name | SPINE & MUSCULOSKELETAL CENTER PC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 2020 E COLUMBUS DRIVE SUITE B
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3078
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Country | US
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Telephone | 219-397-8648
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Fax | 219-397-8653
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Provider Business Mailing Address
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Address Line | 9430 WICKER AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-9768
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Country | US
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Telephone | 219-558-8068
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Fax | 219-558-8149
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH P SPOTT
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Credential | DO
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Telephone | 219-397-8648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 2001917
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License Number State | IN
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