Med Quad Spine Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MED QUAD SPINE CENTER

Practice address

4125 Cleveland Ave Ste 1870
Fort Myers, FL 33901-9064

Phone

(239) 400-0956

Fax

(239) 400-0109

NPI assigned

Sep 20, 2021

Organization subpart

Yes

Parent organization

CONCIERGE MEDICAL SVC II INCAs reported in NPPES

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

Authorized official

Name

Holly Schisani, DO

Title

Medical Director

Phone

(561) 482-1144

Specialties & licenses 2

Addresses

Other names 1

• MED QUAD SPINE CENTER Doing business as

Electronic endpoints 1

Part of

Med Quad Spine Center

Locations

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1386314482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9858 CLINT MOORE RD # C111-274",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334961034",
            "telephone_number": "561-482-1144",
            "fax_number": "561-482-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 CLEVELAND AVE STE 1870",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019064",
            "telephone_number": "239-400-0956",
            "fax_number": "239-400-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED QUAD SPINE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONCIERGE MEDICAL SVC II INC",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "SCHISANI",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "561-482-1144",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "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": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "DROPBOX",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "MEDICAL RECORDS",
            "address_1": "4125 Cleveland Ave Ste 1870",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339019064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MED QUAD SPINE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.