Provider Demographics
NPI:1548377302
Name:CULLMAN SPINE INSTITUTE INC
Entity type:Organization
Organization Name:CULLMAN SPINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-734-7707
Mailing Address - Street 1:1300 BRIDGE CREEK DR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1300
Mailing Address - Country:US
Mailing Address - Phone:256-734-7707
Mailing Address - Fax:256-734-7796
Practice Address - Street 1:1300 BRIDGE CREEK DR NE
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1300
Practice Address - Country:US
Practice Address - Phone:256-734-7707
Practice Address - Fax:256-734-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366514945OtherPATRICK SWINEA - PHYSICAL
158863807OtherJENNIFER KNOWLTON - PHYSI
AL009939046Medicaid
158863807OtherJENNIFER KNOWLTON - PHYSI
1366514945OtherPATRICK SWINEA - PHYSICAL