MEDICARE: SPINE ALIGN 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	CH1250	FL

General Provider Information

NPI Number	:	1205152527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE ALIGN INC

Provider Business Mailing Address
First Line	:	195 S WESTMONTE DR STE 1120
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-4219
Country	:	US
Telephone Number	:	407-862-8834
Fax Number	:	407-862-5951

Provider Business Practice Location Address
First Line	:	195 S WESTMONTE DR STE 1120
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-4219
Country	:	US
Telephone Number	:	407-862-8834
Fax Number	:	407-862-5951

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. WILLIAM PERRY WEBB II
Credential	:	D.C.
Telephone Number	:	407-862-8834

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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Directions to “SPINE ALIGN INC ” Practice Location

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