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General NPI Number Information
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NPI Number | 1770738361
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Entity Type | Organization
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Legal Business Name | TENTH AVENUE MEDICAL, INC.
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 4259 10TH AVE N
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City | LAKE WORTH
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State | FL
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Zip | 33461-2323
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Country | US
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Telephone | 561-642-7770
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Fax | 561-642-7776
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Provider Business Mailing Address
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Address Line | 4259 10TH AVE N
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City | LAKE WORTH
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State | FL
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Zip | 33461-2323
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Country | US
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Telephone | 561-642-7770
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Fax | 561-642-7776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY SCOTT SCHNEIDER
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Credential | D.C.
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Telephone | 561-642-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH 4362
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License Number State | FL
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