=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942729645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD FALK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2017
-----------------------------------------------------
Last Update Date | 09/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6201 N FEDERAL HWY #5-6
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-409-4840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6201 N. FEDERAL HWY #5-6
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-409-4840
-----------------------------------------------------
Fax | 561-409-4578
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH3756
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------