NPIMap

Organization Active NPI

Spinalaid, LLC

  • Family Medicine Physician
  • Avon, IN
National Provider Identifier
1932317666
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01017401 Issued in IN
Legal business name
SPINALAID, LLC
Practice address
106 N State Road 267
Avon, IN 46123-8475
Phone
(317) 272-4100
Fax
(317) 272-4110
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

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

Authorized official

Name
Mrs. Mary Lou Dettmer
Title
Office Manager
Phone
(317) 272-4100

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 08000607A IN
Radiology ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0200X 08000607A IN
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 01017401 IN Primary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X 99018585A IN

Addresses

Primary practice location

106 N State Road 267
Avon, IN 46123-8475

Mailing address

106 N State Road 267
Avon, IN 46123-8475
Phone (317) 272-4100

Other names 1

  • Team Chiropractic, LLC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1932317666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N STATE ROAD 267",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461238475",
            "telephone_number": "317-272-4100",
            "fax_number": "317-272-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N STATE ROAD 267",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461238475",
            "telephone_number": "317-272-4100",
            "fax_number": "317-272-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINALAID, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "DETTMER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOU",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "317-272-4100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08000607A",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Radiology",
            "state": "IN",
            "license": "08000607A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01017401",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "99018585A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Chiropractic, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Avon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; 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.