Provider Demographics
NPI:1942599683
Name:CORAL SPRINGS SPINE & NERVE, INC
Entity Type:Organization
Organization Name:CORAL SPRINGS SPINE & NERVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIYAH
Authorized Official - Middle Name:TAMAR
Authorized Official - Last Name:STOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-752-7373
Mailing Address - Street 1:9720 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4004
Mailing Address - Country:US
Mailing Address - Phone:954-752-7373
Mailing Address - Fax:954-752-7351
Practice Address - Street 1:9720 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4004
Practice Address - Country:US
Practice Address - Phone:954-752-7373
Practice Address - Fax:954-752-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08142111N00000X
GACHIRO08697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty