Provider Demographics
NPI:1235314949
Name:FINE SPINE, LLC
Entity Type:Organization
Organization Name:FINE SPINE, LLC
Other - Org Name:TEXAS HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:PETERS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-451-7979
Mailing Address - Street 1:6800 MANHATTAN BLVD
Mailing Address - Street 2:BG 1 STE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1200
Mailing Address - Country:US
Mailing Address - Phone:817-451-7979
Mailing Address - Fax:817-451-7545
Practice Address - Street 1:6800 MANHATTAN BLVD
Practice Address - Street 2:BG 1 STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1200
Practice Address - Country:US
Practice Address - Phone:817-451-7979
Practice Address - Fax:817-451-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676622Medicare Oscar/Certification