Healthcare Provider Details

I. General information

NPI: 1245649920
Provider Name (Legal Business Name): SURFSIDE NON-SURGICAL ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N OCEAN BLVD SUITE 101
BOYNTON BEACH FL
33435-7365
US

IV. Provider business mailing address

4600 N OCEAN BLVD SUITE 101
BOYNTON BEACH FL
33435-7365
US

V. Phone/Fax

Practice location:
  • Phone: 561-901-3170
  • Fax:
Mailing address:
  • Phone: 561-901-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS9761
License Number StateFL

VIII. Authorized Official

Name: DR. GLENN S CHAPMAN III
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 561-901-3170