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General NPI Number Information
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NPI Number | 1821310178
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Entity Type | Organization
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Legal Business Name | INTEGRITY SPINE CENTER INC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 1850 S CLYDE MORRIS BLVD SUITE C1
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1579
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Country | US
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Telephone | 386-290-4808
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Fax | 386-675-6591
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Provider Business Mailing Address
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Address Line | 1872 FOROUGH CIR
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City | PORT ORANGE
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State | FL
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Zip | 32128-6018
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Country | US
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Telephone | 386-290-4808
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Fax | 386-675-6591
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHRISTOPHER L TATALOVICH
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Credential | DC
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Telephone | 386-290-4808
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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 | CH9744
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License Number State | FL
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