Provider Demographics
NPI:1093862401
Name:SPINAL CARE PLUS PA
Entity Type:Organization
Organization Name:SPINAL CARE PLUS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR NEUROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-784-7800
Mailing Address - Street 1:714 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3757
Mailing Address - Country:US
Mailing Address - Phone:850-784-7800
Mailing Address - Fax:850-784-7825
Practice Address - Street 1:714 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3757
Practice Address - Country:US
Practice Address - Phone:850-784-7800
Practice Address - Fax:850-784-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7828111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1828Medicaid
FLK1828Medicare ID - Type UnspecifiedMEDICARE
FLK1828Medicaid