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General NPI Number Information
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NPI Number | 1376749309
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Entity Type | Organization
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Legal Business Name | ABBA SPINE CENTER, INC.
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1026 W MICHIGAN ST
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City | ORLANDO
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State | FL
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Zip | 32805-5447
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Country | US
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Telephone | 407-835-0047
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Fax | 407-835-0015
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Provider Business Mailing Address
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Address Line | PO BOX 555927
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City | ORLANDO
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State | FL
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Zip | 32855-5927
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Country | US
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Telephone | 407-835-0047
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Fax | 407-835-0015
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROY PETER CARLSON
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Credential | D.C.
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Telephone | 352-360-3601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH3219
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License Number State | FL
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