Provider Demographics
NPI:1295610020
Name:SPINAL CONNECTIONS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SPINAL CONNECTIONS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KLEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-505-7600
Mailing Address - Street 1:1118 SANDALWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4213
Mailing Address - Country:US
Mailing Address - Phone:951-505-7600
Mailing Address - Fax:951-505-7600
Practice Address - Street 1:415 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-7327
Practice Address - Country:US
Practice Address - Phone:951-505-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care