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General NPI Number Information
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NPI Number | 1164612388
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Entity Type | Organization
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Legal Business Name | PURA VIDA CHIROPRACTIC CENTER PA
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 11435 W PALMETTO PARK RD STE G
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City | BOCA RATON
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State | FL
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Zip | 33428-2602
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Country | US
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Telephone | 561-487-3788
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Fax | 561-487-3166
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Provider Business Mailing Address
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Address Line | 11435 W PALMETTO PARK RD STE G
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City | BOCA RATON
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State | FL
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Zip | 33428-2602
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Country | US
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Telephone | 561-487-3788
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Fax | 561-487-3166
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ISRAEL MALDONADO JR.
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Credential | CHIROPRACTOR
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Telephone | 561-487-3788
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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 | CH6133
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License Number State | FL
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