Healthcare Provider Details

I. General information

NPI: 1972789964
Provider Name (Legal Business Name): COMPLETE REHAB & MEDICAL CENTER OF WEST PALM BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4935 OKEECHOBEE BLVD
WEST PALM BEACH FL
33417-4629
US

IV. Provider business mailing address

PO BOX 741235
BOYNTON BEACH FL
33474-1235
US

V. Phone/Fax

Practice location:
  • Phone: 561-682-9383
  • Fax: 567-682-9499
Mailing address:
  • Phone: 561-682-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7924
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH5093
License Number StateFL

VIII. Authorized Official

Name: DR. BRIAN DAVID BAUER
Title or Position: PRESIDENT
Credential: D.O
Phone: 954-818-8283