Healthcare Provider Details

I. General information

NPI: 1235431875
Provider Name (Legal Business Name): HARMONY SPINE AND DISC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE DIXIE HWY SUITE 2
STUART FL
34994-3054
US

IV. Provider business mailing address

500 SE DIXIE HWY SUITE 2
STUART FL
34994-3054
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-7701
  • Fax: 772-220-4473
Mailing address:
  • Phone: 772-287-7701
  • Fax: 772-220-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCH 3653
License Number StateFL

VIII. Authorized Official

Name: DR. RANDY V. HANSBROUGH
Title or Position: DIRECTOR
Credential: D.C.
Phone: 772-287-7701