Provider Demographics
NPI:1720185861
Name:GAINESVILLE MED SPA P.A.
Entity type:Organization
Organization Name:GAINESVILLE MED SPA P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DOM
Authorized Official - Phone:352-374-0909
Mailing Address - Street 1:4715 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6034
Mailing Address - Country:US
Mailing Address - Phone:352-374-0909
Mailing Address - Fax:352-505-3485
Practice Address - Street 1:4061 NW 43RD ST
Practice Address - Street 2:SUITE 16
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-2513
Practice Address - Country:US
Practice Address - Phone:352-374-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty