MEDICARE: PMB HEALTH SOLUTIONS, LLC

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

General Provider Information

NPI Number	:	1437761145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMB HEALTH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1520 10TH AVE N STE A
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2069
Country	:	US
Telephone Number	:	561-585-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 10TH AVE N STE A
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2069
Country	:	US
Telephone Number	:	561-585-6150
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	AILEEN RASCH
Credential	:
Telephone Number	:	772-404-8378

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	10/30/2020

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