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General NPI Number Information
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NPI Number | 1174706485
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Entity Type | Organization
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Legal Business Name | SPORTS AND SPINE INJURY CENTER PA
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 654 W INDIANTOWN RD SUITE 107
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City | JUPITER
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State | FL
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Zip | 33458-7546
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Country | US
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Telephone | 561-745-1002
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Fax | 561-745-7880
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Provider Business Mailing Address
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Address Line | 654 W INDIANTOWN RD SUITE 107
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City | JUPITER
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State | FL
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Zip | 33458-7546
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Country | US
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Telephone | 561-745-1002
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Fax | 561-745-7880
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Authorized Official
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Title or Position | PRESIDENT/DOCTOR
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Name | DR. AUGUST JOHN LA RUFFA III
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Credential | DC
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Telephone | 561-745-1002
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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 | CH6529
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License Number State | FL
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