Brett Spack, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36002164A Issued in IN

Practice address

1402 Chase CT
Carmel, IN 46032-7502

Phone

(317) 848-5867

NPI assigned

Feb 13, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1104240902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5131 CALLAN DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462543774",
            "telephone_number": "317-246-8715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 CHASE CT",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460327502",
            "telephone_number": "317-848-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACK",
        "first_name": "BRETT",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-13",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36002164A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Sovine
• Matthew D Sowder, DPT
• Keena C Sowers Zinn, MSW, NBC-HWC
• Sarah Sowle
• Brandon Spack, ATC, LAT
• Allison Spaeth
• Diadra Spalding, MHC
• Tayzha Span
• Layla Nisan-Simon Spanenberg, RPH
• William Jenkins Spanenberg, MD

• Athletic Trainer in Carmel, IN
• Providers in Carmel, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.