Provider Demographics
NPI:1891031282
Name:FANNEY SPINE AND REHAB, P.A.
Entity Type:Organization
Organization Name:FANNEY SPINE AND REHAB, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-616-1982
Mailing Address - Street 1:504 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7010
Mailing Address - Country:US
Mailing Address - Phone:407-616-1982
Mailing Address - Fax:
Practice Address - Street 1:4241 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4881
Practice Address - Country:US
Practice Address - Phone:407-616-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty