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General NPI Number Information
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NPI Number | 1174762157
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Entity Type | Organization
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Legal Business Name | HALIFAX SPINE CENTER
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 1180 W GRANADA BLVD SUITE D
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8165
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Country | US
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Telephone | 386-290-9505
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Fax |
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Provider Business Mailing Address
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Address Line | 117 SPRINGWOOD DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | HOLLY SMITH
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Credential | DC
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Telephone | 386-290-9505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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