Healthcare Provider Details

I. General information

NPI: 1407269640
Provider Name (Legal Business Name): BACK 2 BACK CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9469 SHERIDAN ST
HOLLYWOOD FL
33024-8561
US

IV. Provider business mailing address

9469 SHERIDAN ST
HOLLYWOOD FL
33024-8561
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-5775
  • Fax: 954-432-2525
Mailing address:
  • Phone: 954-432-5775
  • Fax: 954-432-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH7496
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL HERMAN
Title or Position: OWNER
Credential: CHIROPRACTOR
Phone: 954-432-5775