Provider Demographics
NPI:1245655208
Name:SPICUZZO CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SPICUZZO CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPICUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-797-5132
Mailing Address - Street 1:12781 ORANGE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8912
Mailing Address - Country:US
Mailing Address - Phone:561-797-5132
Mailing Address - Fax:866-715-7529
Practice Address - Street 1:100 S MILITARY TRL STE 18
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-570-4080
Practice Address - Fax:866-715-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10306261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty