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General NPI Number Information
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NPI Number | 1811276595
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Entity Type | Organization
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Legal Business Name | PONCIANA CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 3540 FOREST HILL BLVD SUITE 203
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5878
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Country | US
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Telephone | 561-963-9033
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 FOREST HILL BLVD SUITE 203
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5878
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Country | US
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Telephone | 561-963-9033
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANTONIO A ALFONSO SR.
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Credential |
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Telephone | 561-963-9033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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