Provider Demographics
NPI:1881434421
Name:ADVANCED SPINE AND SPECIALISTS LLC
Entity type:Organization
Organization Name:ADVANCED SPINE AND SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANDALIARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-524-7246
Mailing Address - Street 1:1046 W BUSCH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7714
Mailing Address - Country:US
Mailing Address - Phone:813-524-7246
Mailing Address - Fax:
Practice Address - Street 1:1046 W BUSCH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7714
Practice Address - Country:US
Practice Address - Phone:813-524-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SPINE AND SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty