Provider Demographics
NPI:1558035436
Name:ISLAND SPINE CENTER INC.
Entity Type:Organization
Organization Name:ISLAND SPINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-687-9320
Mailing Address - Street 1:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1666
Mailing Address - Country:US
Mailing Address - Phone:508-687-9320
Mailing Address - Fax:508-955-5070
Practice Address - Street 1:5 UPPER DOUGLAS RD.
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-1666
Practice Address - Country:US
Practice Address - Phone:508-687-9320
Practice Address - Fax:508-955-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110105860AMedicaid