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General NPI Number Information
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NPI Number | 1841837978
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Entity Type | Organization
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Legal Business Name | SPINE BY DESIGN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 3190 SUNTREE BLVD STE 101
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5741
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Country | US
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Telephone | 386-453-7599
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Fax |
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Provider Business Mailing Address
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Address Line | 3190 SUNTREE BLVD STE 101
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5741
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Country | US
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Telephone | 321-622-4501
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AMANDA COURTNEY
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Credential | DC
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Telephone | 321-622-4501
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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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