Organization
BREVARD ORTHOPAEDIC SPINE & 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
2222 S HARBOR CITY BLVD, SUITE 530, MELBOURNE, FL 32901-5594
(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
111N00000X
Chiropractor
—
—
225100000X
Physical Therapist
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040225700
—
FL
01
—
99949
MEDICARE
FL
Enumeration date
06/02/2011
Last updated
07/15/2021
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