=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528480746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOAH M SEGAL DC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2014
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9825 MARINA BLVD STE 300
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-6628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-883-0090
-----------------------------------------------------
Fax | 561-883-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9825 MARINA BLVD STE 300
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-6628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-883-0090
-----------------------------------------------------
Fax | 561-883-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NOAH SEGAL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 561-883-0090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00709000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH11924
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------