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NPI Code Detail

MEDICARE: DR. ELIAS FORMA D.C, DACADC

MEDICARE: DR. ELIAS FORMA D.C, DACADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH7733FL
2111N00000XChiropractorCH 7733FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CH7733OTHERFLFLORIDA LISENCE

General Provider Information

NPI Number : 1538198247
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIAS FORMA D.C, DACADC
Provider Business Mailing Address
First Line : 348 EASTWOOD TER
Second Line :
City : BOCA RATON
State : FL
Zip : 33431-8264
Country : US
Telephone Number : 954-536-1647
Fax Number : 561-276-2474
Provider Business Practice Location Address
First Line : 4665 W ATLANTIC AVE STE C
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-3800
Country : US
Telephone Number : 156-127-6222
Fax Number : 561-276-2474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/28/2024

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