Organization Active NPI

Spinal Therapeutics, Inc

  • Family Medicine Physician
  • Dearborn, MI
National Provider Identifier
1184717738
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101006701 Issued in MI
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

Updated by the provider on Aug 22, 2020

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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 Directory

Locations

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.

Verify at the official NPI Registry.