Provider Demographics
NPI:1043547607
Name:GENESIS SPINE ASSOCIATES, INC
Entity type:Organization
Organization Name:GENESIS SPINE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-378-9991
Mailing Address - Street 1:6101 WINDCOM CT
Mailing Address - Street 2:STE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 W WALL ST
Practice Address - Street 2:STE 101
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7414
Practice Address - Country:US
Practice Address - Phone:817-481-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6306410003Medicare NSC