Organization
SPINE AXIS MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE WRIGHT (CEO)
(909) 373-4633
Entity
Organization
Contact information
Practice address
10808 FOOTHILL BLVD, SUITE 160-409, RANCHO CUCAMONGA, CA 91730-3889
(909) 373-4633
Mailing address
10808 FOOTHILL BLVD, SUITE 160-409, RANCHO CUCAMONGA, CA 91730-3889
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
246RP1900X
Phlebotomy Technician
—
—
246YC3302X
Physician Office Based Coding Specialist
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
247200000X
Other Technician
—
—
2472E0500X
EEG Technician
—
—
305R00000X
Preferred Provider Organization
—
—
305S00000X
Point of Service
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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