| Restorative Spine & Joint | |
|
3596 Skyway Dr Ste B Santa Maria CA 93455-2514 | |
| (805) 614-7820 | |
| Not Available |
| Full Name | Restorative Spine & Joint |
|---|---|
| Speciality | General Practice |
| Location | 3596 Skyway Dr Ste B, Santa Maria, California |
| Authorized Official Name and Position | Matthew Egbert (CEO) |
| Authorized Official Contact | 8056147820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restorative Spine & Joint 3596 Skyway Dr Ste B Santa Maria CA 93455-2514 Ph: (805) 614-7820 | Restorative Spine & Joint 3596 Skyway Dr Ste B Santa Maria CA 93455-2514 Ph: (805) 614-7820 |
| NPI Number | 1053872713 |
|---|---|
| Provider Enumeration Date | 03/26/2019 |
| Last Update Date | 09/12/2023 |
| Medicare PECOS PAC ID | 1355678905 |
|---|---|
| Medicare Enrollment ID | O20190806001514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053872713 | NPI | - | NPPES |
| 1205806874 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Matthew R Egbert |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1205806874 PECOS PAC ID: 7911898549 Enrollment ID: I20040323001197 |
| Provider Name | Tina M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073958070 PECOS PAC ID: 6800102039 Enrollment ID: I20150902000457 |
| Provider Name | Tabitha Elise Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811558042 PECOS PAC ID: 8325469893 Enrollment ID: I20200609002375 |
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