Provider Demographics
NPI:1386314482
Name:MED QUAD SPINE CENTER
Entity type:Organization
Organization Name:MED QUAD SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHISANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-482-1144
Mailing Address - Street 1:9858 CLINT MOORE RD # C111-274
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:561-482-1144
Mailing Address - Fax:561-482-1145
Practice Address - Street 1:4125 CLEVELAND AVE STE 1870
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9064
Practice Address - Country:US
Practice Address - Phone:239-400-0956
Practice Address - Fax:239-400-0109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCIERGE MEDICAL SVC II INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty