Provider Demographics
NPI:1033873484
Name:UNIVERSITY SPINE AND INJURY
Entity Type:Organization
Organization Name:UNIVERSITY SPINE AND INJURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIFSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-792-0284
Mailing Address - Street 1:4907 NW 43RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-2007
Mailing Address - Country:US
Mailing Address - Phone:352-792-0284
Mailing Address - Fax:
Practice Address - Street 1:4907 NW 43RD ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-2007
Practice Address - Country:US
Practice Address - Phone:352-792-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty