Healthcare Provider Details

I. General information

NPI: 1396866562
Provider Name (Legal Business Name): CHIRO-MEDICAL ASSOCIATES OF HOLLYWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 NW CORPORATE BLVD SUITE 140
BOCA RATON FL
33431-7323
US

IV. Provider business mailing address

2832 STIRLING RD UNIT E
HOLLYWOOD FL
33020-1127
US

V. Phone/Fax

Practice location:
  • Phone: 561-241-1971
  • Fax: 561-241-3969
Mailing address:
  • Phone: 954-929-1211
  • Fax: 954-929-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC3659
License Number StateFL

VIII. Authorized Official

Name: EVAN SADE
Title or Position: CONSULTING
Credential:
Phone: 954-817-9402