Provider Demographics
NPI:1003037474
Name:NORTHWOOD SPORTS MEDICINE & PHYSICAL REHABILITATION INC
Entity Type:Organization
Organization Name:NORTHWOOD SPORTS MEDICINE & PHYSICAL REHABILITATION INC
Other - Org Name:ANDERSON CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-683-4971
Mailing Address - Street 1:2790 N MILITARY TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2926
Mailing Address - Country:US
Mailing Address - Phone:561-683-4971
Mailing Address - Fax:561-478-4946
Practice Address - Street 1:2790 N MILITARY TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2926
Practice Address - Country:US
Practice Address - Phone:561-683-4971
Practice Address - Fax:561-478-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6427111NR0400X
FLCH1504111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381442400Medicaid
FLK0573Medicare ID - Type Unspecified