# THE SPINE INSTITUTE AT ORTHOPAEDIC ASSOCIATES PL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396072765
- **Authorized official:** DR. KORNELIS A POELSTRA MD (PHYSICIAN)
- **Authorized official phone:** (850) 797-6027

## Contact information

- **Practice address:** 1034 MAR WALT DR, SUITE 310, FORT WALTON BEACH, FL 32547-6645
- **Practice address phone:** (850) 797-6027
- **Practice address fax:** (850) 797-6027
- **Mailing address:** 1034 MAR WALT DR, SUITE 310, FORT WALTON BEACH, FL 32547-6645
- **Mailing address phone:** (850) 797-6027
- **Mailing address fax:** (850) 797-6027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2009
- **Last updated:** 06/02/2012