Provider Demographics
NPI:1558970640
Name:FX SPINE AND PERFORMANCE CENTER, LLC
Entity type:Organization
Organization Name:FX SPINE AND PERFORMANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-557-5926
Mailing Address - Street 1:824 KESTREL DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0328
Mailing Address - Country:US
Mailing Address - Phone:717-557-5926
Mailing Address - Fax:
Practice Address - Street 1:106 SRP DR STE B
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4358
Practice Address - Country:US
Practice Address - Phone:706-842-6800
Practice Address - Fax:706-842-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty