Provider Demographics
NPI:1669359782
Name:PRIMO SPINE LLC
Entity type:Organization
Organization Name:PRIMO SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:SUK
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-217-6969
Mailing Address - Street 1:14414 BLACK LAKE PRESERVE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5242
Mailing Address - Country:US
Mailing Address - Phone:321-274-3951
Mailing Address - Fax:407-217-6971
Practice Address - Street 1:1805 MAGUIRE RD STE 135
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7924
Practice Address - Country:US
Practice Address - Phone:407-217-6969
Practice Address - Fax:407-217-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty