Provider Demographics
NPI:1194904870
Name:PALM HARBOR SPINE CENTER INC
Entity type:Organization
Organization Name:PALM HARBOR SPINE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-479-8802
Mailing Address - Street 1:1440 LAWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3806
Mailing Address - Country:US
Mailing Address - Phone:727-479-8802
Mailing Address - Fax:727-781-0439
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-771-7200
Practice Address - Fax:727-781-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI310Medicare PIN