Provider Demographics
NPI:1922211713
Name:TREASURE COAST SPINE INSTITUTE, INC.
Entity Type:Organization
Organization Name:TREASURE COAST SPINE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:VICKNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-219-1456
Mailing Address - Street 1:3880 SE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6055
Mailing Address - Country:US
Mailing Address - Phone:772-219-1456
Mailing Address - Fax:772-219-1449
Practice Address - Street 1:3880 SE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6055
Practice Address - Country:US
Practice Address - Phone:772-219-1456
Practice Address - Fax:772-219-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386704583Medicare ID - Type UnspecifiedCHIROPRACTOR
FL1972663169Medicare ID - Type UnspecifiedCHIROPRACTOR