Provider Demographics
NPI:1144694613
Name:SPINE-ABILITY CHIROPRACTIC & REHAB
Entity type:Organization
Organization Name:SPINE-ABILITY CHIROPRACTIC & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FETHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-561-6565
Mailing Address - Street 1:6152 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1806
Mailing Address - Country:US
Mailing Address - Phone:586-255-0393
Mailing Address - Fax:
Practice Address - Street 1:6152 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1806
Practice Address - Country:US
Practice Address - Phone:586-255-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty