Provider Demographics
NPI:1760026439
Name:SPINE IN LINE, LLC
Entity Type:Organization
Organization Name:SPINE IN LINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RAMOS MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-407-3690
Mailing Address - Street 1:219 BRIAR CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4410
Mailing Address - Country:US
Mailing Address - Phone:787-407-3690
Mailing Address - Fax:
Practice Address - Street 1:421 MONTGOMERY RD STE 165
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-6824
Practice Address - Country:US
Practice Address - Phone:407-960-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE IN LINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty