Provider Demographics
NPI:1811236656
Name:SPORT & SPINAL REHAB LLC
Entity Type:Organization
Organization Name:SPORT & SPINAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:NEVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-406-6905
Mailing Address - Street 1:103 S US HIGHWAY 1 STE B4
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5101
Mailing Address - Country:US
Mailing Address - Phone:561-406-6905
Mailing Address - Fax:561-406-6913
Practice Address - Street 1:103 S US HIGHWAY 1 STE B4
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5101
Practice Address - Country:US
Practice Address - Phone:561-406-6905
Practice Address - Fax:561-406-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty