Provider Demographics
NPI:1447339692
Name:SPINEONE
Entity type:Organization
Organization Name:SPINEONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-367-2225
Mailing Address - Street 1:191 UNIVERSITY BLVD # 509
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4613
Mailing Address - Country:US
Mailing Address - Phone:303-367-2225
Mailing Address - Fax:303-751-0561
Practice Address - Street 1:1411 S POTOMAC ST STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4538
Practice Address - Country:US
Practice Address - Phone:303-367-2225
Practice Address - Fax:303-751-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000377612081P2900X, 208VP0014X
CO2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804191Medicare ID - Type UnspecifiedMCR ID NUMBER