Provider Demographics
NPI:1780007039
Name:TAMPA SPINE & WELLNESS LLC
Entity Type:Organization
Organization Name:TAMPA SPINE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-212-7571
Mailing Address - Street 1:205 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3600
Mailing Address - Country:US
Mailing Address - Phone:813-331-5753
Mailing Address - Fax:
Practice Address - Street 1:8575 MONTRAVAIL CIR APT 731
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-3036
Practice Address - Country:US
Practice Address - Phone:352-212-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty