Provider Demographics
NPI:1134846066
Name:MATRIX SPINE AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:MATRIX SPINE AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:954-228-8486
Mailing Address - Street 1:43 S POWERLINE RD STE 245
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3001
Mailing Address - Country:US
Mailing Address - Phone:954-228-8486
Mailing Address - Fax:954-228-2601
Practice Address - Street 1:150 SW 12TH AVE STE 440
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3200
Practice Address - Country:US
Practice Address - Phone:954-228-8486
Practice Address - Fax:954-228-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty