MEDICARE: NORTH BAY SPINE AND REHAB

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	CH10459	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	:	1760918940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BAY SPINE AND REHAB

Provider Business Mailing Address
First Line	:	2431 BRUNELLO TRCE
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-7800
Country	:	US
Telephone Number	:	813-999-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 BRUNELLO TRCE
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-7800
Country	:	US
Telephone Number	:	813-999-3330
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRETT BOWSER
Credential	:	D.C.
Telephone Number	:	724-859-0784

Provider Enumeration Date	:	05/07/2017
Last Update Date	:	05/07/2017

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Directions to “NORTH BAY SPINE AND REHAB ” Practice Location

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