Provider Demographics
NPI:1124224613
Name:SPINAL HEALTH AND REHAB
Entity Type:Organization
Organization Name:SPINAL HEALTH AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN NOSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:BS DC
Authorized Official - Phone:941-205-2180
Mailing Address - Street 1:2905 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7272
Mailing Address - Country:US
Mailing Address - Phone:941-205-2180
Mailing Address - Fax:941-205-2181
Practice Address - Street 1:2905 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7272
Practice Address - Country:US
Practice Address - Phone:941-205-2180
Practice Address - Fax:941-205-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV08831Medicare UPIN
FL65924ZMedicare ID - Type Unspecified