MEDICARE: CORAL SPRINGS SPINE & NERVE, 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	CHIRO08697	GA
2	111N00000X	Chiropractor	CHIRO08142	GA

General Provider Information

NPI Number	:	1942599683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL SPRINGS SPINE & NERVE, INC

Provider Business Mailing Address
First Line	:	9720 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4004
Country	:	US
Telephone Number	:	954-752-7373
Fax Number	:	954-752-7351

Provider Business Practice Location Address
First Line	:	9720 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4004
Country	:	US
Telephone Number	:	954-752-7373
Fax Number	:	954-752-7351

Authorized Official
Title or Position	:	CO OWNER
Name	:	DR. ALIYAH TAMAR STOTTER
Credential	:	D.C.
Telephone Number	:	954-752-7373

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	05/12/2011

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Directions to “CORAL SPRINGS SPINE & NERVE, INC ” Practice Location

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