Healthcare Provider Details

I. General information

NPI: 1558597625
Provider Name (Legal Business Name): ACCIDENT AND WELLNESS CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 NORTH LAKE BLVD
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

PO BOX 6455
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-2821
  • Fax: 651-627-0542
Mailing address:
  • Phone: 561-429-5840
  • Fax: 561-429-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME98091
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME62002
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9389
License Number StateFL

VIII. Authorized Official

Name: DR. RAFAEL FOSS
Title or Position: MM
Credential: DC. BS.
Phone: 786-370-1111