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General NPI Number Information
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NPI Number | 1376278846
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Entity Type | Organization
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Legal Business Name | PRO ACTIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8794 BOYNTON BEACH BLVD STE 216
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4469
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Country | US
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Telephone | 561-376-2462
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 SPRING HARBOR DR APT G
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6884
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Country | US
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Telephone | 561-676-6256
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRANDON RHODES
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Credential | DC
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Telephone | 561-376-2462
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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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