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General NPI Number Information
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NPI Number | 1174753214
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Entity Type | Organization
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Legal Business Name | ELITE REHABILITATION SERVICE CENTER
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 2125 10TH AVE N
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City | LAKE WORTH
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State | FL
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Zip | 33461-3349
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Country | US
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Telephone | 561-585-0040
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Fax | 561-585-0043
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Provider Business Mailing Address
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Address Line | 2125 10TH AVE NORTH
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City | LAKE WORTH
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State | FL
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Zip | 33461
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Country | US
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Telephone | 561-585-0040
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Fax | 561-585-0043
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JUAN C PADILLA SR.
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Credential |
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Telephone | 561-585-0040
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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 | CH 4496
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License Number State | FL
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