Provider Demographics
NPI:1699022095
Name:FLORIDA SPINE & DISC
Entity Type:Organization
Organization Name:FLORIDA SPINE & DISC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-929-5600
Mailing Address - Street 1:5315 PARK PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1464
Mailing Address - Country:US
Mailing Address - Phone:561-929-5600
Mailing Address - Fax:
Practice Address - Street 1:5315 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1464
Practice Address - Country:US
Practice Address - Phone:561-929-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty