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General NPI Number Information
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NPI Number | 1578415436
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Entity Type | Organization
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Legal Business Name | SPINALLY360, LLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1542 KINGSLEY AVE STE 143
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City | ORANGE PARK
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State | FL
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Zip | 32073-4547
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Country | US
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Telephone | 904-800-7843
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Fax | 324-202-2375
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Provider Business Mailing Address
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Address Line | 1542 KINGSLEY AVE STE 143
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City | ORANGE PARK
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State | FL
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Zip | 32073-4547
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Country | US
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Telephone | 904-800-7843
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Fax | 324-202-2375
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Authorized Official
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Title or Position | CEO
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Name | DR. MARCDA ERNEZA HILAIRE BRUNOT
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Credential | DC
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Telephone | 904-800-7843
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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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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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