Healthcare Provider Details

I. General information

NPI: 1649406711
Provider Name (Legal Business Name): POMPANO CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 EAST ATLANTIC BLVD. SUITE 104
POMPANO BEACH FL
33060
US

IV. Provider business mailing address

P.O BOX 6455
WEST PALM BEACH FL
33405
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-2821
  • Fax: 561-627-2821
Mailing address:
  • Phone: 561-429-5640
  • Fax: 561-429-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9389
License Number StateFL

VIII. Authorized Official

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