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General NPI Number Information
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NPI Number | 1891029294
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Entity Type | Organization
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Legal Business Name | ATLANTIC GROVE CHIROPRACTIC & REHABILITATION, INC.
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 7815 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1345
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Country | US
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Telephone | 561-455-4850
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Fax | 561-995-0138
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Provider Business Mailing Address
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Address Line | 7815 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1345
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Country | US
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Telephone | 561-455-4850
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Fax | 561-995-0138
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEYED HESSAM KHATAMI
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Credential | D.C.
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Telephone | 561-455-4850
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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 | CH9743
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License Number State | FL
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