MEDICARE: BACK TO HEALTH OF SOUTH FLORIDA, INC

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
1	174400000X	Specialist	CH8206	FL

General Provider Information

NPI Number	:	1669481727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO HEALTH OF SOUTH FLORIDA, INC

Provider Business Mailing Address
First Line	:	301 CAMINO GARDENS BLVD
Second Line	:	SUITE 201
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5823
Country	:	US
Telephone Number	:	561-394-8770
Fax Number	:	561-394-3615

Provider Business Practice Location Address
First Line	:	301 CAMINO GARDENS BLVD
Second Line	:	SUITE 201
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5823
Country	:	US
Telephone Number	:	561-394-8770
Fax Number	:	561-394-3615

Authorized Official
Title or Position	:	PRESIDENT
Name	:	XAVIER M ESCOBAR
Credential	:	D.C.
Telephone Number	:	561-394-8770

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/22/2020

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