Provider Demographics
NPI:1083014930
Name:FLORIDA SPINE AND WELLNESS INSTITUTE CORPORATION
Entity Type:Organization
Organization Name:FLORIDA SPINE AND WELLNESS INSTITUTE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-677-9355
Mailing Address - Street 1:33 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6401
Mailing Address - Country:US
Mailing Address - Phone:386-677-9355
Mailing Address - Fax:
Practice Address - Street 1:4 PEARL DR
Practice Address - Street 2:SUITE #1
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1926
Practice Address - Country:US
Practice Address - Phone:386-677-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty