Provider Demographics
NPI:1255931010
Name:SPINE WELL INC
Entity type:Organization
Organization Name:SPINE WELL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-444-6165
Mailing Address - Street 1:650 CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4090
Mailing Address - Country:US
Mailing Address - Phone:941-444-6165
Mailing Address - Fax:941-493-5088
Practice Address - Street 1:650 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4090
Practice Address - Country:US
Practice Address - Phone:941-444-6165
Practice Address - Fax:941-493-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty