MEDICARE: INTEGRATED SPINE AND PAIN CENTER OF FLORIDA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LA2200X	Adult Health Nurse Practitioner
2	111N00000X	Chiropractor
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1942675251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED SPINE AND PAIN CENTER OF FLORIDA INC

Provider Business Mailing Address
First Line	:	29141 CHAPEL PARK DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4423
Country	:	US
Telephone Number	:	813-994-5200
Fax Number	:	813-994-5700

Provider Business Practice Location Address
First Line	:	29141 CHAPEL PARK DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4423
Country	:	US
Telephone Number	:	813-994-5200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARRETT L SOLDANO
Credential	:	DC
Telephone Number	:	269-381-2800

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	02/10/2016

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