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General NPI Number Information
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NPI Number | 1407073299
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Entity Type | Organization
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Legal Business Name | DYNAMIC MEDICAL REHABILITATION CENTER OF DEERFIELD BEACH
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 342 S POWERLINE RD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-8105
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Country | US
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Telephone | 954-421-2005
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Fax | 954-421-4285
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Provider Business Mailing Address
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Address Line | 342 S POWERLINE RD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-8105
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Country | US
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Telephone | 954-421-2005
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Fax | 954-421-4285
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL R BASTKOWSKI
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Credential | M.D.
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Telephone | 954-421-2005
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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 | CH7166
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License Number State | FL
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