| The Spine Group LLC | |
|
12061 Tejon St Ste 600 Westminster CO 80234-2325 | |
| (303) 457-0123 | |
| (303) 252-4065 |
| Full Name | The Spine Group LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 12061 Tejon St Ste 600, Westminster, Colorado |
| Authorized Official Name and Position | Warner M Hettick (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3034570123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Spine Group LLC 12061 Tejon St Ste 600 Westminster CO 80234-2325 Ph: (303) 457-0123 | The Spine Group LLC 12061 Tejon St Ste 600 Westminster CO 80234-2325 Ph: (303) 457-0123 |
| NPI Number | 1033486006 |
|---|---|
| Provider Enumeration Date | 11/18/2011 |
| Last Update Date | 11/09/2020 |
| Certification Date | 11/09/2020 |
| Medicare PECOS PAC ID | 5698938298 |
|---|---|
| Medicare Enrollment ID | O20120619000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033486006 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| 111N00000X | Chiropractor | (NU) | Secondary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
| Provider Name | Tamara Rae Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992739890 PECOS PAC ID: 7618905704 Enrollment ID: I20120601000305 |
| Provider Name | Warner M Hettick |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1134445984 PECOS PAC ID: 9931230489 Enrollment ID: I20150107001964 |
| Provider Name | Jillian M Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760928998 PECOS PAC ID: 3971880964 Enrollment ID: I20170428001504 |
| Provider Name | Courtney Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124586573 PECOS PAC ID: 8729313010 Enrollment ID: I20190709001414 |
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