| Spokane Sport & Spine | |
|
3209 E 57th Ave Ste F Spokane WA 99223-7040 | |
| (509) 720-1117 | |
| Not Available |
| Full Name | Spokane Sport & Spine |
|---|---|
| Speciality | Clinic/Center |
| Location | 3209 E 57th Ave, Spokane, Washington |
| Authorized Official Name and Position | Ryan D Johnson (DOCTOR OF CHIROPRACTIC) |
| Authorized Official Contact | 5097201117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spokane Sport & Spine 5428 S Regal St Po Box 31032 Spokane WA 99223-8153 Ph: () - | Spokane Sport & Spine 3209 E 57th Ave Ste F Spokane WA 99223-7040 Ph: (509) 720-1117 |
| NPI Number | 1376097279 |
|---|---|
| Provider Enumeration Date | 08/09/2016 |
| Last Update Date | 08/09/2016 |
| Medicare PECOS PAC ID | 5496034035 |
|---|---|
| Medicare Enrollment ID | O20161122001577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376097279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | CH60130771 (Washington) | Primary |
| Provider Name | Ryan D Johnson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1780816389 PECOS PAC ID: 0042356917 Enrollment ID: I20100414001000 |
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