Healthcare Provider Details

I. General information

NPI: 1558142935
Provider Name (Legal Business Name): PREMIER SPORTS CHIROPRACTIC AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE SPANISH RIVER BLVD STE 21
BOCA RATON FL
33431-4517
US

IV. Provider business mailing address

500 NE SPANISH RIVER BLVD STE 21
BOCA RATON FL
33431-4517
US

V. Phone/Fax

Practice location:
  • Phone: 561-961-0420
  • Fax:
Mailing address:
  • Phone: 561-961-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT YOUNGROSS
Title or Position: CHIROPRACTOR / OWNER
Credential: DC
Phone: 561-715-9686