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General NPI Number Information
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NPI Number | 1124567730
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC & GENETIC WELLNESS, LLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1401 S OCEAN BLVD #302
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City | BOCA RATON
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State | FL
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Zip | 33432-8528
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Country | US
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Telephone | 610-212-8700
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Fax | 561-447-4556
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Provider Business Mailing Address
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Address Line | 7035 BERACASA WAY
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City | BOCA RATON
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State | FL
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Zip | 33433-3405
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Country | US
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Telephone | 610-212-8700
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Fax | 561-447-4556
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Authorized Official
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Title or Position | OWNER
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Name | JOAN LEE RUTENBERG
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Credential | DC
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Telephone | 610-212-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8779
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License Number State | FL
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