MEDICARE: SPINE ISLAND INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7634	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093905713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE ISLAND INC

Provider Business Mailing Address
First Line	:	10450 W ATLANTIC BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5605
Country	:	US
Telephone Number	:	954-345-2663
Fax Number	:	954-510-4951

Provider Business Practice Location Address
First Line	:	10450 W ATLANTIC BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5605
Country	:	US
Telephone Number	:	954-345-2663
Fax Number	:	954-510-4951

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID JAY GOLINGER
Credential	:	D.C.
Telephone Number	:	954-345-2663

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	05/09/2008

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Directions to “SPINE ISLAND INC ” Practice Location

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