Provider Demographics
NPI:1073043360
Name:FAMILY SPORT AND SPINE LLC
Entity Type:Organization
Organization Name:FAMILY SPORT AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANI
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-822-9095
Mailing Address - Street 1:196 SPRING ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3849
Mailing Address - Country:US
Mailing Address - Phone:732-822-9095
Mailing Address - Fax:
Practice Address - Street 1:196 SPRING ST APT 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3849
Practice Address - Country:US
Practice Address - Phone:732-822-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty