Provider Demographics
NPI:1225308323
Name:TAMPA BAY SPINE INSTITUTE, INC.
Entity Type:Organization
Organization Name:TAMPA BAY SPINE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-234-4444
Mailing Address - Street 1:717 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3103
Mailing Address - Country:US
Mailing Address - Phone:813-234-4444
Mailing Address - Fax:813-234-3800
Practice Address - Street 1:717 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3103
Practice Address - Country:US
Practice Address - Phone:813-234-4444
Practice Address - Fax:813-234-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty