Provider Demographics
NPI:1083075857
Name:MIAMI SPINE CENTER, PA
Entity Type:Organization
Organization Name:MIAMI SPINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:REISECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-432-1911
Mailing Address - Street 1:PO BOX 772467
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0042
Mailing Address - Country:US
Mailing Address - Phone:305-432-1911
Mailing Address - Fax:
Practice Address - Street 1:15680 SW 88TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1160
Practice Address - Country:US
Practice Address - Phone:305-432-1911
Practice Address - Fax:305-255-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty