MEDICARE: DOR CHIROPRACTIC & WELLNESS CENTER 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	111N00000X	Chiropractor	CH 11130	FL

General Provider Information

NPI Number	:	1710399928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOR CHIROPRACTIC & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	2100 LAKE IDA RD STE 1
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-2442
Country	:	US
Telephone Number	:	561-450-6097
Fax Number	:	561-450-6372

Provider Business Practice Location Address
First Line	:	2100 LAKE IDA RD STE 1
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-2442
Country	:	US
Telephone Number	:	561-450-6097
Fax Number	:	561-450-6372

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. COLLEEN STEPHANIE DOR
Credential	:	D.C.
Telephone Number	:	561-450-6097

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	03/23/2023

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