Provider Demographics
NPI:1558695866
Name:TREASURE COAST SPINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:TREASURE COAST SPINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VICKNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-260-5555
Mailing Address - Street 1:6140 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8105
Mailing Address - Country:US
Mailing Address - Phone:772-260-5555
Mailing Address - Fax:772-872-5205
Practice Address - Street 1:6140 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8105
Practice Address - Country:US
Practice Address - Phone:772-260-5555
Practice Address - Fax:772-872-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty