Provider Demographics
NPI:1780923417
Name:PROSPINE PLC
Entity type:Organization
Organization Name:PROSPINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JABAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-524-0007
Mailing Address - Street 1:4646 POPLAR AVE
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4646 POPLAR AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4426
Practice Address - Country:US
Practice Address - Phone:716-524-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty