MEDICARE: WOOLBRIGHT SPINAL CARE, INC

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	111NR0400X	Rehabilitation Chiropractor	11422	FL

General Provider Information

NPI Number	:	1326576372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOLBRIGHT SPINAL CARE, INC

Provider Business Mailing Address
First Line	:	7350 THATCHER AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-5242
Country	:	US
Telephone Number	:	561-810-8017
Fax Number	:	561-810-8021

Provider Business Practice Location Address
First Line	:	2240 W WOOLBRIGHT RD STE 209
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6363
Country	:	US
Telephone Number	:	561-810-8017
Fax Number	:	561-810-8021

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. WESNER MENTOR
Credential	:	DC
Telephone Number	:	561-810-8017

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	06/02/2017

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