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General NPI Number Information
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NPI Number | 1245649920
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Entity Type | Organization
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Legal Business Name | SURFSIDE NON-SURGICAL ORTHOPEDICS
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 4600 N OCEAN BLVD SUITE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7365
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Country | US
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Telephone | 561-901-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 N OCEAN BLVD SUITE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7365
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Country | US
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Telephone | 561-901-3170
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GLENN S CHAPMAN III
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Credential | D.O.
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Telephone | 561-901-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | OS9761
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License Number State | FL
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