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General NPI Number Information
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NPI Number | 1104437078
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Entity Type | Organization
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Legal Business Name | RESTORATION SPINE AND SPORT, LLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 1217 W MILLER ST STE 1
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-3029
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Country | US
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Telephone | 527-500-2773
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Fax | 352-260-0240
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Provider Business Mailing Address
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Address Line | 1217 W MILLER ST STE 1
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-3029
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Country | US
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Telephone | 352-750-0277
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Fax | 352-260-0240
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. MATTHEW JOSEPH UHRIK
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Credential | DC
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Telephone | 847-894-8901
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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 |
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License Number State |
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