Healthcare Provider Details

I. General information

NPI: 1497964407
Provider Name (Legal Business Name): PALM BEACH OSTEOPATHIC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10887 N MILITARY TRL STE 5
PALM BEACH GARDENS FL
33410-6528
US

IV. Provider business mailing address

10887 N MILITARY TRL STE 5
PALM BEACH GARDENS FL
33410-6528
US

V. Phone/Fax

Practice location:
  • Phone: 561-324-9600
  • Fax: 561-799-9980
Mailing address:
  • Phone: 561-324-9600
  • Fax: 561-799-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS9152
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS9152
License Number StateFL

VIII. Authorized Official

Name: MRS. DEBORAH DODGE
Title or Position: AM
Credential: PHYSICIAN'S WIFE
Phone: 561-324-9600