Provider Demographics
NPI:1316448715
Name:VITAL SPINE CENTER, INC.
Entity type:Organization
Organization Name:VITAL SPINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHITSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-960-3902
Mailing Address - Street 1:4063 N GOLDENROD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8905
Mailing Address - Country:US
Mailing Address - Phone:407-960-3902
Mailing Address - Fax:407-960-1745
Practice Address - Street 1:4063 N GOLDENROD RD STE 1
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8905
Practice Address - Country:US
Practice Address - Phone:407-960-3902
Practice Address - Fax:407-960-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1649536426OtherNPI