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Organization
BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC
Active
Organization
BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC
Active
Other names
The BACK CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD A HYNES MD (PRESIDENT)
(321) 541-1537
Entity
Organization
Contact information
Practice address
2222 S. HARBOR CITY BLVD, SUITE 610, MELBOURNE, FL 32901-5591
(321) 723-7716
(321) 723-0604
Mailing address
2222 S. HARBOR CITY BLVD, SUITE 610, MELBOURNE, FL 32901-5591
(321) 723-7716
(321) 723-0604
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040225700
—
FL
Enumeration date
03/02/2006
Last updated
07/15/2021
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