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Organization
BREVARD ORTHOPAEDIC SPINE AND PAIN CLINIC, INC
Active
Organization
BREVARD ORTHOPAEDIC SPINE AND PAIN CLINIC, INC
Active
Parent organization
BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC, INC
Other names
The BACK Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC, INC
Authorized official
KATRINA LOPEZ (CREDENTIALING)
(321) 541-1537
Entity
Organization
Contact information
Practice address
7227 N US HIGHWAY 1, PORT ST JOHN, FL 32927-5020
(321) 723-7716
(321) 723-0604
Mailing address
2222 S HARBOR CITY BLVD, SUITE 610, MELBOURNE, FL 32901-5594
(321) 723-7716
(321) 723-0604
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040225700
—
FL
Enumeration date
05/18/2011
Last updated
07/15/2021
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