Provider Demographics
NPI:1407053739
Name:SOUTHWEST SPINAL CARE
Entity Type:Organization
Organization Name:SOUTHWEST SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-596-2225
Mailing Address - Street 1:10651 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1915
Mailing Address - Country:US
Mailing Address - Phone:239-596-2225
Mailing Address - Fax:239-566-7246
Practice Address - Street 1:10651 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1915
Practice Address - Country:US
Practice Address - Phone:239-596-2225
Practice Address - Fax:239-566-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710026778OtherNPI OF MURRAY JOHNSTON
FL6447250001Medicare NSC