Healthcare Provider Details

I. General information

NPI: 1851907828
Provider Name (Legal Business Name): TOTAL SPINE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1938
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1906
US

V. Phone/Fax

Practice location:
  • Phone: 321-499-4646
  • Fax:
Mailing address:
  • Phone: 321-499-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN STEWART
Title or Position: CEO/CFO
Credential:
Phone: 813-731-5143