Organization
BREVARD ORTHOPAEDIC SPINE AND PAIN CLINIC, INC
Active
Parent organization
BREVARD ORTHOPAEDIC SPINE AND PAIN CLINIC, INC
Other names
The BACK Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BREVARD ORTHOPAEDIC SPINE AND PAIN CLINIC, INC
Authorized official
KATRINA LOPEZ (CREDENTIALING)
(321) 541-1537
Entity
Organization
Contact information
Practice address
650 S COURTENAY PKWY, SUITE 100, MERRITT ISLAND, FL 32952-4977
(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
01
—
99949
MEDICARE
FL
Enumeration date
05/18/2011
Last updated
07/15/2021
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