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General NPI Number Information
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NPI Number | 1760918940
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Entity Type | Organization
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Legal Business Name | NORTH BAY SPINE AND REHAB
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 05/07/2017
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Provider Practice Location Address
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Address Line | 2431 BRUNELLO TRCE
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City | LUTZ
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State | FL
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Zip | 33558-7800
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Country | US
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Telephone | 813-999-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 BRUNELLO TRCE
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City | LUTZ
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State | FL
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Zip | 33558-7800
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Country | US
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Telephone | 813-999-3330
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRETT BOWSER
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Credential | D.C.
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Telephone | 724-859-0784
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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 | CH10459
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License Number State | FL
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