Healthcare Provider Details

I. General information

NPI: 1578408571
Provider Name (Legal Business Name): SOUTHERN COAST SPINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SE DIXIE HWY
STUART FL
34994-3045
US

IV. Provider business mailing address

510 SE DIXIE HWY
STUART FL
34994-3045
US

V. Phone/Fax

Practice location:
  • Phone: 772-600-7751
  • Fax: 772-600-7659
Mailing address:
  • Phone: 772-600-7751
  • Fax: 772-600-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER CHADWICK ROBERT
Title or Position: CEO
Credential: DO
Phone: 772-600-7751