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General NPI Number Information
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NPI Number | 1104069699
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH CHIROPRACTIC
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 16213 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33027-4572
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Country | US
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Telephone | 954-805-3553
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Fax | 954-431-5074
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Provider Business Mailing Address
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Address Line | 7760 ALHAMBRA BLVD
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City | MIRAMAR
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State | FL
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Zip | 33023-5820
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Country | US
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Telephone | 954-961-2449
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Fax | 954-961-2449
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DENNIS GOULDBOURNE
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Credential | D.C.
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Telephone | 954-805-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CH9067
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License Number State | FL
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