Provider Demographics
NPI:1679745905
Name:SPOKANE BRAIN & SPINE, PS
Entity type:Organization
Organization Name:SPOKANE BRAIN & SPINE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEMAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-744-3490
Mailing Address - Street 1:801 W 5TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-744-3490
Mailing Address - Fax:509-744-3499
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-744-3490
Practice Address - Fax:509-744-3499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOKANE BRAIN & SPINE, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty