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General NPI Number Information
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NPI Number | 1942599683
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Entity Type | Organization
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Legal Business Name | CORAL SPRINGS SPINE & NERVE, INC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 9720 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4004
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Country | US
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Telephone | 954-752-7373
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Fax | 954-752-7351
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Provider Business Mailing Address
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Address Line | 9720 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4004
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Country | US
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Telephone | 954-752-7373
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Fax | 954-752-7351
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. ALIYAH TAMAR STOTTER
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Credential | D.C.
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Telephone | 954-752-7373
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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 | CHIRO08697
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO08142
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License Number State | GA
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