Provider Demographics
NPI:1932503547
Name:S FL SPINE & JOINT PORT ST LUCIE
Entity Type:Organization
Organization Name:S FL SPINE & JOINT PORT ST LUCIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-686-3201
Mailing Address - Street 1:1501 PRESIDENTIAL WAY STE 19
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1852
Mailing Address - Country:US
Mailing Address - Phone:561-686-3201
Mailing Address - Fax:561-686-1622
Practice Address - Street 1:6688 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1422
Practice Address - Country:US
Practice Address - Phone:772-461-7333
Practice Address - Fax:772-461-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007758111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty