Provider Demographics
NPI:1205152527
Name:SPINE ALIGN INC
Entity type:Organization
Organization Name:SPINE ALIGN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:407-862-8834
Mailing Address - Street 1:195 S WESTMONTE DR STE 1120
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4219
Mailing Address - Country:US
Mailing Address - Phone:407-862-8834
Mailing Address - Fax:407-862-5951
Practice Address - Street 1:195 S WESTMONTE DR STE 1120
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4219
Practice Address - Country:US
Practice Address - Phone:407-862-8834
Practice Address - Fax:407-862-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty