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General NPI Number Information
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NPI Number | 1962624593
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Entity Type | Organization
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Legal Business Name | GENESIS SPINE ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 6101 WINDCOM CT STE 300
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City | PLANO
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State | TX
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Zip | 75093-7817
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Country | US
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Telephone | 972-378-9991
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Fax | 972-378-9992
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Provider Business Mailing Address
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Address Line | 6101 WINDCOM CT STE 300
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City | PLANO
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State | TX
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Zip | 75093-7817
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Country | US
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Telephone | 972-378-9991
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Fax | 972-378-9992
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Authorized Official
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Title or Position | OWNER
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Name | NICK J COLEMAN
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Credential | DC
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Telephone | 972-378-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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