MEDICARE: SPINE BY DESIGN CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841837978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE BY DESIGN CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3190 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5741
Country	:	US
Telephone Number	:	321-622-4501
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5741
Country	:	US
Telephone Number	:	386-453-7599
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. AMANDA COURTNEY
Credential	:	DC
Telephone Number	:	321-622-4501

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	02/18/2020

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