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General NPI Number Information
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NPI Number | 1922399096
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Entity Type | Organization
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Legal Business Name | SPINE & SPORT CHIROPRACTIC CLINIC P.A.
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 2649 WINDGUARD CIR SUITE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7358
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Country | US
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Telephone | 813-973-9800
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Fax | 813-994-8200
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Provider Business Mailing Address
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Address Line | 2649 WINDGUARD CIR SUITE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7358
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Country | US
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Telephone | 813-973-9800
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Fax | 813-994-8200
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Authorized Official
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Title or Position | CEO
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Name | DR. BRYAN WILLIAM SCHMIED
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Credential | D.C.
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Telephone | 813-973-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | CH10057
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License Number State | FL
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