Provider Demographics
NPI:1871668095
Name:SPINE CONSULTANTS PC
Entity type:Organization
Organization Name:SPINE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:KLEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-873-5800
Mailing Address - Street 1:1400 S POTOMAC ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4528
Mailing Address - Country:US
Mailing Address - Phone:303-873-5800
Mailing Address - Fax:303-671-4968
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-873-5800
Practice Address - Fax:303-671-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30108207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01301084Medicaid
COCOB4049Medicare PIN
E56314Medicare UPIN