Provider Demographics
NPI:1649611625
Name:SPA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SPA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-759-7591
Mailing Address - Street 1:16 N EUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3408
Mailing Address - Country:US
Mailing Address - Phone:201-759-7591
Mailing Address - Fax:352-357-3028
Practice Address - Street 1:16 N EUSTIS ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3408
Practice Address - Country:US
Practice Address - Phone:201-759-7591
Practice Address - Fax:352-357-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH11019OtherCHIROPRACTIC PHYSICIAN LICENSE