Provider Demographics
NPI:1881152353
Name:SEASIDE SPINE CRESTVIEW LLC
Entity type:Organization
Organization Name:SEASIDE SPINE CRESTVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-460-2362
Mailing Address - Street 1:981 HIGHWAY 98 E STE 9
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2588
Mailing Address - Country:US
Mailing Address - Phone:850-460-2362
Mailing Address - Fax:
Practice Address - Street 1:610 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-7356
Practice Address - Country:US
Practice Address - Phone:850-460-2362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEASIDE SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-04
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty