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General NPI Number Information
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NPI Number | 1629343249
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINE AND WELLNESS CENTER, INC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 3840 COLONIAL BLVD SUITE 2
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City | FORT MYERS
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State | FL
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Zip | 33966-1013
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Country | US
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Telephone | 239-489-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3840 COLONIAL BLVD SUITE 2
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City | FORT MYERS
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State | FL
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Zip | 33966-1013
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Country | US
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Telephone | 239-489-1000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT STOLTZ
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Credential | D.C.
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Telephone | 239-489-1000
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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 | CH8458
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License Number State | FL
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