Healthcare Provider Details

I. General information

NPI: 1891739256
Provider Name (Legal Business Name): LEO ROY MINSKY D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S MILITARY TRL SUITE 110
DEERFIELD BEACH FL
33442-7688
US

IV. Provider business mailing address

2501 W HILLSBORO BLVD STE 107
DEERFIELD BEACH FL
33442-8437
US

V. Phone/Fax

Practice location:
  • Phone: 954-421-1839
  • Fax: 954-698-9314
Mailing address:
  • Phone: 954-421-1839
  • Fax: 954-698-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: