Provider Demographics
NPI:1831428366
Name:NECK AND BACK PAIN INSTITUTE, INC
Entity type:Organization
Organization Name:NECK AND BACK PAIN INSTITUTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-575-4045
Mailing Address - Street 1:10251 W SAMPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-575-4045
Mailing Address - Fax:954-575-5983
Practice Address - Street 1:10251 W SAMPLE ROAD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-575-4045
Practice Address - Fax:954-575-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3178111NR0400X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty