MEDICARE: CORRECTIVE SPINAL CARE 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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1780284596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRECTIVE SPINAL CARE INC

Provider Business Mailing Address
First Line	:	6965 PIAZZA GRANDE AVE STE 207
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8780
Country	:	US
Telephone Number	:	321-246-5358
Fax Number	:

Provider Business Practice Location Address
First Line	:	6965 PIAZZA GRANDE AVE STE 207
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8780
Country	:	US
Telephone Number	:	321-246-5358
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	DR. KETTIA C CHERENFANT
Credential	:	NP
Telephone Number	:	321-246-5358

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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