Provider Demographics
NPI:1558547927
Name:NON-SURGICAL SPINE & DISC CARE CTR, INC
Entity Type:Organization
Organization Name:NON-SURGICAL SPINE & DISC CARE CTR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLENBERGER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:239-728-3472
Mailing Address - Street 1:12951 METRO PKWY
Mailing Address - Street 2:5
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8340
Mailing Address - Country:US
Mailing Address - Phone:239-728-3472
Mailing Address - Fax:239-489-1314
Practice Address - Street 1:12951 METRO PKWY
Practice Address - Street 2:5
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-8340
Practice Address - Country:US
Practice Address - Phone:239-728-3472
Practice Address - Fax:239-489-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2118111N00000X
FLCH7948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53890Medicare PIN
FLU82067Medicare UPIN