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General NPI Number Information
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NPI Number | 1720637218
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Entity Type | Individual
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Provider Name | ABANOUB BOUTROS DC
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Gender | Male
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 5801 S DIXIE HWY STE A
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-3651
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Country | US
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Telephone | 561-308-7145
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 S DIXIE HWY UNIT 2313
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City | LANTANA
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State | FL
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Zip | 33462-5524
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Country | US
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Telephone | 561-308-7145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH12909
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License Number State | FL
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