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General NPI Number Information
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NPI Number | 1760026439
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Entity Type | Organization
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Legal Business Name | SPINE IN LINE, LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 421 MONTGOMERY RD STE 165
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-6824
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Country | US
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Telephone | 407-960-4010
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Fax |
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Provider Business Mailing Address
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Address Line | 219 BRIAR CLIFF DR
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City | LONGWOOD
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State | FL
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Zip | 32779-4410
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Country | US
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Telephone | 787-407-3690
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PAOLA MARIE RAMOS MONTALVO
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Credential | DC
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Telephone | 787-407-3690
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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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