Provider Demographics
NPI:1992112577
Name:SALUS ORTHOPEDIC & SPINE LLC
Entity type:Organization
Organization Name:SALUS ORTHOPEDIC & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-560-6764
Mailing Address - Street 1:15880 SUMMERLIN RD
Mailing Address - Street 2:SUITE-300 PMB 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9612
Mailing Address - Country:US
Mailing Address - Phone:239-603-6212
Mailing Address - Fax:877-711-7411
Practice Address - Street 1:8191 COLLEGE PKWY
Practice Address - Street 2:SUITE-205
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5190
Practice Address - Country:US
Practice Address - Phone:239-603-6212
Practice Address - Fax:877-711-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8431111NN0400X
FLOS00007123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty