Provider Demographics
NPI:1811339815
Name:FRONTIER SPINE AND HEALTH CARE LLC
Entity type:Organization
Organization Name:FRONTIER SPINE AND HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:TOLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-353-4325
Mailing Address - Street 1:10661 SW 88TH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8709
Mailing Address - Country:US
Mailing Address - Phone:786-353-4325
Mailing Address - Fax:305-279-8999
Practice Address - Street 1:10661 SW 88TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8709
Practice Address - Country:US
Practice Address - Phone:786-353-4325
Practice Address - Fax:305-279-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDI092Medicare PIN