St John Dynamic Spine Center

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

ST JOHN DYNAMIC SPINE CENTER

Practice address

31700 Van Dyke Ave
Suite 160
Warren, MI 48093-7949

Phone

(248) 649-2323

Fax

(248) 649-5998

NPI assigned

May 25, 2010

Organization subpart

No

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

Authorized official

Name

Becky McDonald

Title

Vice President

Phone

(248) 649-2323

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Henry Ford Health Macomb-Oakland Hospital

  • Family Medicine Physician
  • Madison Heights, MI
  • NPI 1720390453

  Member Of

  NPD member

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274745600000",
    "number": "1598084980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W BIG BEAVER RD",
            "address_2": "SUITE 150",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480843545",
            "telephone_number": "248-649-2323",
            "fax_number": "248-649-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31700 VAN DYKE AVE",
            "address_2": "SUITE 160",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937949",
            "telephone_number": "248-649-2323",
            "fax_number": "248-649-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN DYNAMIC SPINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-25",
        "last_updated": "2010-05-25",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "248-649-2323"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SS Medical Equipment, Inc.
• SSC Warren Operating Company LLC
• SSS Home Care LLC
• St Anthony Acquisition Company Inc
• St Clair Adult Care PC
• St John Health System- Detroit-Macomb Campus
• St John Hospital and Medical Center
• St John Macomb Oakland Hospital
• St John Macomb Oakland Hospital
• St John Macomb Oakland Hospital

• Physical Medicine & Rehabilitation Physician in Warren, MI
• Providers in Warren, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; 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.