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General NPI Number Information
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NPI Number | 1063804169
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Entity Type | Organization
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Legal Business Name | SIMPLY SPINE CLINICS
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 27501 PLAYA DEL REY LN
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-3555
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Country | US
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Telephone | 978-340-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 27501 PLAYA DEL REY LN
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-3555
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Country | US
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Telephone | 978-340-1045
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Fax |
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Authorized Official
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Title or Position | CLINIC DOCTOR
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Name | DR. DANE CUNNINGHAM
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Credential | D.C.
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Telephone | 978-340-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11388
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License Number State | FL
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