Provider Demographics
NPI:1730191032
Name:SPINE INJURY CLINICS
Entity type:Organization
Organization Name:SPINE INJURY CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKOLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-208-0101
Mailing Address - Street 1:6853 COIT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5466
Mailing Address - Country:US
Mailing Address - Phone:972-208-0101
Mailing Address - Fax:972-208-0100
Practice Address - Street 1:6853 COIT RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5466
Practice Address - Country:US
Practice Address - Phone:972-208-0101
Practice Address - Fax:972-208-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TX8744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R8170OtherBCBS
TX0044MGOtherBCBS
TX1730191032Medicaid
U82675Medicare UPIN