MEDICARE: COMPLETE REHAB & MEDICAL CENTER OF WEST PALM BEACH

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	CH5093	FL
2	111N00000X	Chiropractor	CH7924	FL

General Provider Information

NPI Number	:	1972789964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE REHAB & MEDICAL CENTER OF WEST PALM BEACH

Provider Business Mailing Address
First Line	:	PO BOX 741235
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33474-1235
Country	:	US
Telephone Number	:	561-682-9383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4629
Country	:	US
Telephone Number	:	561-682-9383
Fax Number	:	567-682-9499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN DAVID BAUER
Credential	:	D.O
Telephone Number	:	954-818-8283

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	04/20/2008

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