Organization Active NPI

Palm Coast Spine and Rehab Inc

  • Pain Medicine Physician
  • Winter Park, FL
National Provider Identifier
1194771808
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
PALM COAST SPINE AND REHAB INC
Practice address
2699 Lee Rd
Suite 505
Winter Park, FL 32789-1753
Phone
(407) 960-3775
Fax
(407) 960-3652
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael J Demchak, DC
Title
President
Phone
(407) 960-3775

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

2699 Lee Rd
Suite 505
Winter Park, FL 32789-1753

Mailing address

2699 Lee Rd
Suite 505
Winter Park, FL 32789-1753
Phone (407) 960-3775

Other names 1

  • same Doing business as

National Provider Directory

National Provider Directory

Locations

9501 Arlington Expy
Ste 318
Jacksonville, FL 32225

29 Old Kings Rd N
Ste 5A
Palm Coast, FL 32137
Phone (386) 446-0630

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1194771808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 LEE RD",
            "address_2": "SUITE 505",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327891753",
            "telephone_number": "407-960-3775",
            "fax_number": "407-960-3652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2699 LEE RD",
            "address_2": "SUITE 505",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327891753",
            "telephone_number": "407-960-3775",
            "fax_number": "407-960-3652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST SPINE AND REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "DEMCHAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-960-3775",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "same",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winter Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.