Provider Demographics
NPI:1568680791
Name:STRAND SPINE INSTITUTE
Entity Type:Organization
Organization Name:STRAND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FICO
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:843-235-3426
Mailing Address - Street 1:12465 OCEAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7133
Mailing Address - Country:US
Mailing Address - Phone:843-235-3426
Mailing Address - Fax:843-235-3427
Practice Address - Street 1:12465 OCEAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7133
Practice Address - Country:US
Practice Address - Phone:843-235-3426
Practice Address - Fax:843-235-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2157Medicaid
SCCH2157Medicaid
SC=========Medicare UPIN