Active NPI
Spinal Therapeutics, Inc
- Family Medicine Physician
- Dearborn, MI
National Provider Identifier
1184717738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101006701
- Legal business name
- SPINAL THERAPEUTICS, INC
- Practice address
- 22731 Newman Suite 102
Dearborn, MI 48123 - Phone
- (313) 792-8472
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jackie Cummings
- Title
- President
- Phone
- (313) 792-8472
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101006701 | MI | Primary |
Addresses
Primary practice location
22731 Newman Suite 102
Dearborn, MI 48123
Mailing address
P.O. Box 2084
Dearborn, MI 48123
National Provider Directory
National Provider DirectoryLocations
22731 Newman St
Ste 102
Dearborn, MI 48124
Phone (313) 792-8472
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1184717738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 2084",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22731 NEWMAN SUITE 102",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48123",
"telephone_number": "313-792-8472"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPINAL THERAPEUTICS, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-02",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "CUMMINGS",
"authorized_official_first_name": "JACKIE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "313-792-8472"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MI",
"license": "5101006701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.