Provider Demographics
NPI:1154147536
Name:NOVA SPINE GROUP
Entity type:Organization
Organization Name:NOVA SPINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-202-4373
Mailing Address - Street 1:109 TAMPA AVE W
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-1728
Mailing Address - Country:US
Mailing Address - Phone:941-202-4373
Mailing Address - Fax:877-719-0086
Practice Address - Street 1:109 TAMPA AVE W
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-1728
Practice Address - Country:US
Practice Address - Phone:941-202-4373
Practice Address - Fax:877-719-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty