Provider Demographics
NPI:1821310178
Name:INTEGRITY SPINE CENTER INC
Entity Type:Organization
Organization Name:INTEGRITY SPINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-290-4808
Mailing Address - Street 1:1872 FOROUGH CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6018
Mailing Address - Country:US
Mailing Address - Phone:386-290-4808
Mailing Address - Fax:386-675-6591
Practice Address - Street 1:1850 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C1
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1579
Practice Address - Country:US
Practice Address - Phone:386-290-4808
Practice Address - Fax:386-675-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty