Provider Demographics
NPI:1891421384
Name:SPINE HEALTH AND WELLNESS SOLUTIONS LLC
Entity Type:Organization
Organization Name:SPINE HEALTH AND WELLNESS SOLUTIONS LLC
Other - Org Name:FLEX SPINE AND SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-262-2530
Mailing Address - Street 1:7034 GALLEON CV
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6519
Mailing Address - Country:US
Mailing Address - Phone:772-262-2530
Mailing Address - Fax:
Practice Address - Street 1:1200 TOWN CENTER DR STE 119
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5257
Practice Address - Country:US
Practice Address - Phone:772-262-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty