Provider Demographics
NPI:1255622049
Name:SPINE & DISC CENTER
Entity type:Organization
Organization Name:SPINE & DISC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MCDANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-375-2308
Mailing Address - Street 1:2233 PARK AVE
Mailing Address - Street 2:200-B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5570
Mailing Address - Country:US
Mailing Address - Phone:904-375-2308
Mailing Address - Fax:904-375-1954
Practice Address - Street 1:2233 PARK AVE
Practice Address - Street 2:200-B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5570
Practice Address - Country:US
Practice Address - Phone:904-375-2308
Practice Address - Fax:904-375-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty