Provider Demographics
NPI:1295916468
Name:FLORIDA BACK INSTITUTE INC
Entity type:Organization
Organization Name:FLORIDA BACK INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERNYHOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-988-8988
Mailing Address - Street 1:1905 CLINT MOORE RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2661
Mailing Address - Country:US
Mailing Address - Phone:561-988-8988
Mailing Address - Fax:561-912-1804
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 309
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2661
Practice Address - Country:US
Practice Address - Phone:561-988-8988
Practice Address - Fax:561-912-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1419Medicare PIN