Provider Demographics
NPI:1164447173
Name:TARPON SPINE CENTER, INC
Entity type:Organization
Organization Name:TARPON SPINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-937-2086
Mailing Address - Street 1:1244 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3720
Mailing Address - Country:US
Mailing Address - Phone:727-937-2086
Mailing Address - Fax:727-939-2554
Practice Address - Street 1:1244 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3720
Practice Address - Country:US
Practice Address - Phone:727-937-2086
Practice Address - Fax:727-939-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381282100Medicaid
U79483Medicare UPIN
FL381282100Medicaid