Provider Demographics
NPI:1952925547
Name:RESTORE SPINE LLC
Entity type:Organization
Organization Name:RESTORE SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HAWK
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-776-4660
Mailing Address - Street 1:PO BOX 66657
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0657
Mailing Address - Country:US
Mailing Address - Phone:480-776-4660
Mailing Address - Fax:
Practice Address - Street 1:165 N BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6714
Practice Address - Country:US
Practice Address - Phone:321-462-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty