Healthcare Provider Details

I. General information

NPI: 1821219155
Provider Name (Legal Business Name): BROWARD SPINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 WASHINGTON ST STE 101
HOLLYWOOD FL
33021-8282
US

IV. Provider business mailing address

3702 WASHINGTON ST STE 101
HOLLYWOOD FL
33021-8282
US

V. Phone/Fax

Practice location:
  • Phone: 954-272-2225
  • Fax: 954-272-0554
Mailing address:
  • Phone: 954-272-2225
  • Fax: 954-272-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL STAUBER
Title or Position: OWNER
Credential: MD
Phone: 954-272-2225