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General NPI Number Information
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NPI Number | 1295610020
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Entity Type | Organization
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Legal Business Name | SPINAL CONNECTIONS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 415 MOUNTAIN DR
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City | DESTIN
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State | FL
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Zip | 32541-7327
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Country | US
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Telephone | 951-505-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 SANDALWOOD CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-4213
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Country | US
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Telephone | 951-505-7600
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Fax | 951-505-7600
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KLEIDY BOTICH
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Credential |
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Telephone | 951-505-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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