NPIMap

Organization Active NPI

Vestavia Spine and Rehabilitation Center LLC

  • Chiropractor
  • Vestavia Hills, AL
National Provider Identifier
1841908571
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
VESTAVIA SPINE AND REHABILITATION CENTER LLC
Practice address
2017 Canyon Rd Ste 21
Vestavia Hills, AL 35216-1928
Phone
(205) 822-8320
Fax
(205) 822-8323
NPI assigned
Nov 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Authorized official

Name
Dr. Deshan Gross, DCNPI 1972652865
Title
Memebr
Phone
(205) 822-8323

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

2017 Canyon Rd Ste 21
Vestavia Hills, AL 35216-1928

Mailing address

2017 Canyon Rd Ste 21
Vestavia Hills, AL 35216-1928
Phone (205) 822-8320

Other names 1

  • Alabama Spine & Rehabilitation Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230329000221 AL Part B Supplier - Clinic/Group Practice 9638543929 Receives reassigned benefits from 3 practitioners
Practice locations: Vestavia Hills, AL

National Provider Directory

National Provider Directory

Locations

2017 Canyon Rd
Ste 21
Vestavia Hills, AL 35216
Phone (205) 822-8320

2017 Canyon Rd
Vestavia Hills, AL 35216
Phone (205) 206-9425

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1668124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1841908571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 CANYON RD STE 21",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161928",
            "telephone_number": "205-822-8320",
            "fax_number": "205-822-8323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 CANYON RD STE 21",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161928",
            "telephone_number": "205-822-8320",
            "fax_number": "205-822-8323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VESTAVIA SPINE AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-11",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "DESHAN",
        "authorized_official_title_or_position": "MEMEBR",
        "authorized_official_telephone_number": "205-822-8323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alabama Spine & Rehabilitation Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Alabama Spine & Rehabilitation Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Vestavia Hills, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.