MEDICARE: DELRAY HEALTH GROUP, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7336	FL

General Provider Information

NPI Number	:	1326226218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELRAY HEALTH GROUP, PA

Provider Business Mailing Address
First Line	:	9212 RUTLEDGE AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-5911
Country	:	US
Telephone Number	:	917-270-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	9212 RUTLEDGE AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-5911
Country	:	US
Telephone Number	:	917-270-5151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAN GOODMAN
Credential	:	DC
Telephone Number	:	917-270-5151

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	04/22/2008

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