Spine Clinic of Baton Rouge

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

024904 Issued in LA

Legal business name

SPINE CLINIC OF BATON ROUGE

Practice address

5211 Essen LN
Suite 1
Baton Rouge, LA 70809-3564

Phone

(225) 766-5050

Fax

(225) 766-2052

NPI assigned

Feb 26, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. George John Ivanicky

Title

Owner

Phone

(225) 766-5050

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477689305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 ESSEN LN",
            "address_2": "SUITE 1",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093564",
            "telephone_number": "225-766-5050",
            "fax_number": "225-766-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 ESSEN LN",
            "address_2": "SUITE 1",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093564",
            "telephone_number": "225-766-5050",
            "fax_number": "225-766-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE CLINIC OF BATON ROUGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IVANICKY",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-766-5050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "LA",
            "license": "024904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shaun R Spinks, M.D.

• Rehabilitation Practitioner in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Rehabilitation Practitioner in Louisiana

• 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.