Provider Demographics
NPI:1174706485
Name:SPORTS AND SPINE INJURY CENTER PA
Entity type:Organization
Organization Name:SPORTS AND SPINE INJURY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LA RUFFA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:561-745-1002
Mailing Address - Street 1:654 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7546
Mailing Address - Country:US
Mailing Address - Phone:561-745-1002
Mailing Address - Fax:561-745-7880
Practice Address - Street 1:654 W INDIANTOWN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7546
Practice Address - Country:US
Practice Address - Phone:561-745-1002
Practice Address - Fax:561-745-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAW490Medicare PIN
AW490Medicare UPIN