Healthcare Provider Details

I. General information

NPI: 1245413194
Provider Name (Legal Business Name): WESTON MEDICAL HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 N COMMERCE PKWY STE 2
WESTON FL
33326-3250
US

IV. Provider business mailing address

2237 N COMMERCE PKWY SUITE 2
WESTON FL
33326-3250
US

V. Phone/Fax

Practice location:
  • Phone: 954-888-6650
  • Fax: 954-888-6645
Mailing address:
  • Phone: 954-888-6650
  • Fax: 954-888-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8366
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9560
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3412
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS ALAN SPOONHOUR JR.
Title or Position: OWNER/DIRECTOR
Credential: D.C.
Phone: 954-888-6650