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General NPI Number Information
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NPI Number | 1669481727
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH OF SOUTH FLORIDA, INC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 CAMINO GARDENS BLVD SUITE 201
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City | BOCA RATON
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State | FL
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Zip | 33432-5823
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Country | US
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Telephone | 561-394-8770
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Fax | 561-394-3615
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Provider Business Mailing Address
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Address Line | 301 CAMINO GARDENS BLVD SUITE 201
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City | BOCA RATON
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State | FL
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Zip | 33432-5823
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Country | US
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Telephone | 561-394-8770
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Fax | 561-394-3615
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Authorized Official
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Title or Position | PRESIDENT
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Name | XAVIER M ESCOBAR
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Credential | D.C.
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Telephone | 561-394-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CH8206
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License Number State | FL
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