Provider Demographics
NPI:1770997454
Name:MEDICAL AND SPINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:MEDICAL AND SPINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-860-2422
Mailing Address - Street 1:2705 REBECCA LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8332
Mailing Address - Country:US
Mailing Address - Phone:386-860-2422
Mailing Address - Fax:386-860-2566
Practice Address - Street 1:2705 REBECCA LN
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8332
Practice Address - Country:US
Practice Address - Phone:386-860-2422
Practice Address - Fax:386-860-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8833OtherSTATE LICENSE
1801022215OtherNPI