Healthcare Provider Details

I. General information

NPI: 1326506270
Provider Name (Legal Business Name): DANIEL J BORMAN II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FOREST HILL BLVD STE 2
PALM SPRINGS FL
33406-5617
US

IV. Provider business mailing address

3600 FOREST HILL BLVD STE 2
PALM SPRINGS FL
33406-5617
US

V. Phone/Fax

Practice location:
  • Phone: 561-766-1232
  • Fax: 561-766-1233
Mailing address:
  • Phone: 561-766-1232
  • Fax: 561-766-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: LUKAS CORREA
Title or Position: MD OFFICE ADMINISTRATOR
Credential:
Phone: 561-766-1232