Provider Demographics
NPI:1093122467
Name:VERO SPINE & SPORT REHAB
Entity Type:Organization
Organization Name:VERO SPINE & SPORT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-617-2185
Mailing Address - Street 1:3730 7TH TER
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7324
Mailing Address - Country:US
Mailing Address - Phone:772-617-2185
Mailing Address - Fax:
Practice Address - Street 1:3730 7TH TER
Practice Address - Street 2:SUITE 302
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7324
Practice Address - Country:US
Practice Address - Phone:772-617-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty