Provider Demographics
NPI:1043808587
Name:IDEAL SPINE CENTERS LLC
Entity type:Organization
Organization Name:IDEAL SPINE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-807-0101
Mailing Address - Street 1:1210 E OSCEOLA PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1621
Mailing Address - Country:US
Mailing Address - Phone:407-807-0101
Mailing Address - Fax:
Practice Address - Street 1:1210 E OSCEOLA PKWY STE 302
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1621
Practice Address - Country:US
Practice Address - Phone:407-807-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty