1053336917 NPI number — SPINAL INTERVENTIONS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053336917 NPI number — SPINAL INTERVENTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINAL INTERVENTIONS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053336917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 RIVER PARK DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84604-5793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-223-4860
Provider Business Mailing Address Fax Number:
801-371-8993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 WEST RIVER PARK DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-5764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-223-4860
Provider Business Practice Location Address Fax Number:
801-371-8993
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FABER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
REY
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-380-6239

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  45356 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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