Provider Demographics
NPI:1811313372
Name:FLORIDA SPINE & WELLNESS CENTER CORP.
Entity type:Organization
Organization Name:FLORIDA SPINE & WELLNESS CENTER CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO/PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMTAEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-438-2772
Mailing Address - Street 1:28023 HWY 27
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4276
Mailing Address - Country:US
Mailing Address - Phone:863-651-7631
Mailing Address - Fax:863-688-2210
Practice Address - Street 1:28023 HWY 27
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4276
Practice Address - Country:US
Practice Address - Phone:863-651-7631
Practice Address - Fax:863-688-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty