Provider Demographics
NPI:1053336917
Name:SPINAL INTERVENTIONS, PLLC
Entity type:Organization
Organization Name:SPINAL INTERVENTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:REY
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:801-223-4860
Mailing Address - Street 1:3214 N UNIVERSITY AVE
Mailing Address - Street 2:# 614
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4405
Mailing Address - Country:US
Mailing Address - Phone:801-223-4860
Mailing Address - Fax:801-371-8993
Practice Address - Street 1:280 WEST RIVER PARK DR
Practice Address - Street 2:STE 200
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5764
Practice Address - Country:US
Practice Address - Phone:801-223-4860
Practice Address - Fax:801-371-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT45356207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00005782Medicare ID - Type Unspecified