Provider Demographics
NPI:1780284596
Name:CORRECTIVE SPINAL CARE INC
Entity type:Organization
Organization Name:CORRECTIVE SPINAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:DR
Authorized Official - First Name:KETTIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHERENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:321-246-5358
Mailing Address - Street 1:6965 PIAZZA GRANDE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8780
Mailing Address - Country:US
Mailing Address - Phone:321-246-5358
Mailing Address - Fax:
Practice Address - Street 1:6965 PIAZZA GRANDE AVE STE 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8780
Practice Address - Country:US
Practice Address - Phone:321-246-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty