Healthcare Provider Details

I. General information

NPI: 1558693887
Provider Name (Legal Business Name): TAINA IVELISSE CORTES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 GLADES RD STE 104
BOCA RATON FL
33434-3988
US

IV. Provider business mailing address

3516 HALDIN PL
ROYAL PALM BEACH FL
33411-8320
US

V. Phone/Fax

Practice location:
  • Phone: 845-304-3198
  • Fax:
Mailing address:
  • Phone: 845-304-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: