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General NPI Number Information
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NPI Number | 1326358375
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Entity Type | Organization
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Legal Business Name | MDR ADVANCED MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 1899 N CONGRESS AVE STE 9
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8215
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Country | US
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Telephone | 561-731-3361
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Fax | 561-731-3374
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Provider Business Mailing Address
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Address Line | 1899 N CONGRESS AVE STE 9
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8215
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Country | US
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Telephone | 561-731-3361
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Fax | 561-731-3374
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK P DIROMA
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Credential | D.C.
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Telephone | 561-731-3361
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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 |
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License Number State |
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