Provider Demographics
NPI:1497128060
Name:CORE SPINE & JOINT
Entity Type:Organization
Organization Name:CORE SPINE & JOINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-505-5077
Mailing Address - Street 1:4110 NW 37TH PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6128
Mailing Address - Country:US
Mailing Address - Phone:352-505-5077
Mailing Address - Fax:
Practice Address - Street 1:4110 NW 37TH PL
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6128
Practice Address - Country:US
Practice Address - Phone:352-505-5077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty