Healthcare Provider Details

I. General information

NPI: 1255097408
Provider Name (Legal Business Name): NEUROPATHY CENTER OF BOCA RATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W YAMATO RD STE A8
BOCA RATON FL
33431-4429
US

IV. Provider business mailing address

2774 WOODFIELD DR
MARYVILLE IL
62062-6476
US

V. Phone/Fax

Practice location:
  • Phone: 618-719-1179
  • Fax:
Mailing address:
  • Phone: 618-719-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN R JACHINO
Title or Position: PRESIDENT
Credential:
Phone: 217-839-3040