Healthcare Provider Details

I. General information

NPI: 1295272797
Provider Name (Legal Business Name): ALAN BRUCE DAUTCH, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 PINE RIDGE RD SUITES E
NAPLES FL
34109-2002
US

IV. Provider business mailing address

2295 NW CORPORATE BLVD #245
BOCA RATON FL
33431-7373
US

V. Phone/Fax

Practice location:
  • Phone: 561-988-1022
  • Fax:
Mailing address:
  • Phone: 561-988-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7578
License Number StateFL

VIII. Authorized Official

Name: ALAN DAUTCH
Title or Position: PRESIDENT
Credential:
Phone: 561-988-1022