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General NPI Number Information
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NPI Number | 1588077374
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Entity Type | Organization
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Legal Business Name | WESTSIDE ADVANCED CARE
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 8148 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2000
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Country | US
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Telephone | 954-370-3100
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Fax | 954-370-3288
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Provider Business Mailing Address
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Address Line | 8148 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2000
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Country | US
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Telephone | 954-370-3100
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Fax | 954-370-3288
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. LONNIE HERMAN
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Credential | DC
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Telephone | 954-370-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | CH7740
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License Number State | FL
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