MEDICARE: GENESIS SPINE ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1396072955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS SPINE ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	6101 WINDCOM CT
Second Line	:	STE 300
City	:	PLANO
State	:	TX
Zip	:	75093-7817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6043 W I-20
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1042
Country	:	US
Telephone Number	:	817-561-6082
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICHOLAS COLEMAN
Credential	:	D.C.
Telephone Number	:	972-378-9991

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	07/14/2010

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