Healthcare Provider Details

I. General information

NPI: 1942675251
Provider Name (Legal Business Name): INTEGRATED SPINE AND PAIN CENTER OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29141 CHAPEL PARK DR
WESLEY CHAPEL FL
33543-4423
US

IV. Provider business mailing address

29141 CHAPEL PARK DR
WESLEY CHAPEL FL
33543-4423
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-5200
  • Fax:
Mailing address:
  • Phone: 813-994-5200
  • Fax: 813-994-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GARRETT L SOLDANO
Title or Position: PRESIDENT
Credential: DC
Phone: 269-381-2800