Healthcare Provider Details

I. General information

NPI: 1174291561
Provider Name (Legal Business Name): SPINAL SOLUTIONS FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 S FLORIDA AVE STE 7
LAKELAND FL
33803-4037
US

IV. Provider business mailing address

2933 S FLORIDA AVE STE 7
LAKELAND FL
33803-4037
US

V. Phone/Fax

Practice location:
  • Phone: 916-800-4947
  • Fax: 407-738-4167
Mailing address:
  • Phone: 916-800-4947
  • Fax: 407-738-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN P HEGARTY
Title or Position: CHIROPRACTOR
Credential: DC,
Phone: 916-800-4947