Provider Demographics
NPI:1235340746
Name:FLORIDA SPINE INSTITUTE OF
Entity Type:Organization
Organization Name:FLORIDA SPINE INSTITUTE OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCARNECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-418-6191
Mailing Address - Street 1:1703 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6169
Mailing Address - Country:US
Mailing Address - Phone:863-467-7377
Mailing Address - Fax:863-467-9688
Practice Address - Street 1:1703 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-6169
Practice Address - Country:US
Practice Address - Phone:863-467-7377
Practice Address - Fax:863-467-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty