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General NPI Number Information
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NPI Number | 1891249579
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Entity Type | Organization
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Legal Business Name | INJURY AND SPINE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 7824 LAKE UNDERHILL RD STE I
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City | ORLANDO
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State | FL
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Zip | 32822-8201
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Country | US
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Telephone | 407-601-1210
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Fax | 407-601-2504
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Provider Business Mailing Address
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Address Line | PO BOX 422210
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City | KISSIMMEE
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State | FL
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Zip | 34742-2210
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Country | US
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Telephone |
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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. KEITH MASSI
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Credential | D.C.
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Telephone | 407-538-2233
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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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