Provider Demographics
NPI:1841837978
Name:SPINE BY DESIGN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SPINE BY DESIGN CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-622-4501
Mailing Address - Street 1:3190 SUNTREE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5741
Mailing Address - Country:US
Mailing Address - Phone:321-622-4501
Mailing Address - Fax:
Practice Address - Street 1:3190 SUNTREE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5741
Practice Address - Country:US
Practice Address - Phone:386-453-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty