Healthcare Provider Details

I. General information

NPI: 1285802629
Provider Name (Legal Business Name): A CENTER FOR ALTERNATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 W PALMETTO PARK RD SUITE 4-554
BOCA RATON FL
33433-3407
US

IV. Provider business mailing address

6018 SW 18TH ST C-11
BOCA RATON FL
33433-7199
US

V. Phone/Fax

Practice location:
  • Phone: 561-417-8383
  • Fax: 561-416-0093
Mailing address:
  • Phone: 561-417-8383
  • Fax: 561-416-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH002538
License Number StateFL

VIII. Authorized Official

Name: DR. LARRY M LEGUNN
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 561-417-8383