Organization · NPI-2

Brevard Orthopaedic Spine & Pain Clinic INC

Orthopaedic Surgery · Melbourne, FL

NPI number1548237100

StatusActive

Last updated in NPPESJul 15, 2021

Details

NPI: 1548237100
Entity type: Organization (NPI-2)
Legal business name: Brevard Orthopaedic Spine & Pain Clinic INC
Organization subpart: No
Enumeration date: Mar 2, 2006
Certification date: Jul 15, 2021
Last updated: Jul 15, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207X00000X	Orthopaedic Surgery	–	–	Yes
111N00000X	Chiropractor	–	–
2081P2900X	Physical Medicine & Rehabilitation, Pain Medicine	–	–
225100000X	Physical Therapist	–	–

Other names

The Back Center (Doing Business As)

Practice location

2222 S. Harbor City Blvd
Suite 610
Melbourne, FL 32901-5591

Phone 321-723-7716 · Fax 321-723-0604

Mailing address

2222 S. Harbor City Blvd
Suite 610
Melbourne, FL 32901-5591

Phone 321-723-7716 · Fax 321-723-0604

Authorized official

Richard A Hynes
President
3215411537

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