Provider Demographics
NPI:1811138191
Name:SPINE2 LLC
Entity type:Organization
Organization Name:SPINE2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-631-1100
Mailing Address - Street 1:3260 MURRELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4407
Mailing Address - Country:US
Mailing Address - Phone:321-631-1100
Mailing Address - Fax:321-637-1030
Practice Address - Street 1:3260 MURRELL RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4407
Practice Address - Country:US
Practice Address - Phone:321-631-1100
Practice Address - Fax:321-637-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty