Healthcare Provider Details

I. General information

NPI: 1205882131
Provider Name (Legal Business Name): BOYNTON BEACH PAIN & REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 W WOOLBRIGHT RD
BOYNTON BEACH FL
33436-7246
US

IV. Provider business mailing address

1814 NE MIAMI GARDENS DR #406
NORTH MIAMI BEACH FL
33179-5043
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-0033
  • Fax: 561-737-4285
Mailing address:
  • Phone: 305-466-5665
  • Fax: 305-466-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8820
License Number StateFL

VIII. Authorized Official

Name: DANNY FEDER
Title or Position: PRESIDENT
Credential: DC
Phone: 305-466-5665