Provider Demographics
NPI:1912655465
Name:SPINE HEALTH LLC
Entity Type:Organization
Organization Name:SPINE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:ADORNO BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTIC
Authorized Official - Phone:787-399-9092
Mailing Address - Street 1:B15 CALLE 4
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5431
Mailing Address - Country:US
Mailing Address - Phone:787-399-9092
Mailing Address - Fax:
Practice Address - Street 1:AVE. CASA LINDA #1, CARR. 177 LOS FILTROS KM 2.0
Practice Address - Street 2:SUITE 101
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-399-9092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM5556Medicaid