Provider Demographics
NPI:1922399096
Name:SPINE & SPORT CHIROPRACTIC CLINIC P.A.
Entity type:Organization
Organization Name:SPINE & SPORT CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHMIED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-973-9800
Mailing Address - Street 1:2649 WINDGUARD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7358
Mailing Address - Country:US
Mailing Address - Phone:813-973-9800
Mailing Address - Fax:813-994-8200
Practice Address - Street 1:2649 WINDGUARD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7358
Practice Address - Country:US
Practice Address - Phone:813-973-9800
Practice Address - Fax:813-994-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10057261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care