# BREVARD ORTHOPAEDIC SPINE & PAIN CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The BACK CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548237100
- **Authorized official:** RICHARD A HYNES MD (PRESIDENT)
- **Authorized official phone:** (321) 541-1537

## Contact information

- **Practice address:** 2222 S. HARBOR CITY BLVD, SUITE 610, MELBOURNE, FL 32901-5591
- **Practice address phone:** (321) 723-7716
- **Practice address fax:** (321) 723-0604
- **Mailing address:** 2222 S. HARBOR CITY BLVD, SUITE 610, MELBOURNE, FL 32901-5591
- **Mailing address phone:** (321) 723-7716
- **Mailing address fax:** (321) 723-0604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 03/02/2006
- **Last updated:** 07/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 040225700 | — | FL |