Provider Demographics
NPI:1386424059
Name:INTEGRITY SPORT AND SPINE LLC
Entity type:Organization
Organization Name:INTEGRITY SPORT AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-264-6091
Mailing Address - Street 1:2445 COUNTRY PLACE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1102
Mailing Address - Country:US
Mailing Address - Phone:727-264-6091
Mailing Address - Fax:727-264-6099
Practice Address - Street 1:2445 COUNTRY PLACE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1102
Practice Address - Country:US
Practice Address - Phone:727-372-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1962042093OtherPERSONAL NPI