Provider Demographics
NPI:1659502631
Name:NECK AND BACK PAIN TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:NECK AND BACK PAIN TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-587-5700
Mailing Address - Street 1:2045 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3936
Mailing Address - Country:US
Mailing Address - Phone:954-587-5700
Mailing Address - Fax:954-587-5709
Practice Address - Street 1:2045 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3936
Practice Address - Country:US
Practice Address - Phone:954-587-5700
Practice Address - Fax:954-587-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001390261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT56078Medicare UPIN