Provider Demographics
NPI:1417444613
Name:OAKLAND PARK SPINAL CARE, INC
Entity Type:Organization
Organization Name:OAKLAND PARK SPINAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESNER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-990-5933
Mailing Address - Street 1:1722 17TH LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4361
Mailing Address - Country:US
Mailing Address - Phone:561-267-6960
Mailing Address - Fax:
Practice Address - Street 1:2700 W OAKLAND PARK BLVD STE 23
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1311
Practice Address - Country:US
Practice Address - Phone:954-990-5933
Practice Address - Fax:954-990-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty