MEDICARE: INTEGRITY SPORT AND SPINE LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962042093	OTHER	FL	PERSONAL NPI

General Provider Information

NPI Number	:	1386424059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY SPORT AND SPINE LLC

Provider Business Mailing Address
First Line	:	2445 COUNTRY PLACE BLVD STE 103
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1102
Country	:	US
Telephone Number	:	727-264-6091
Fax Number	:	727-264-6099

Provider Business Practice Location Address
First Line	:	2445 COUNTRY PLACE BLVD STE 103
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1102
Country	:	US
Telephone Number	:	727-372-9500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. AMBER LYNN KOLLEN
Credential	:	DC
Telephone Number	:	727-264-6091

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	12/08/2023

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Directions to “INTEGRITY SPORT AND SPINE LLC ” Practice Location

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