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General NPI Number Information
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NPI Number | 1457594673
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AND SPORTS REHABILITATION INSTITUTE
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 8794 BOYNTON BEACH BLVD SUITE 107
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4423
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Country | US
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Telephone | 561-271-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 8794 BOYNTON BEACH BLVD SUITE 107
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-4423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID GRANT RUDNICK
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Credential | DC
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Telephone | 561-271-3524
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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 | CH9514
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License Number State | FL
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