Provider Demographics
NPI:1073510921
Name:MALDONADO, ISRAEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:MALDONADO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ISRAEL
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11435 W PALMETTO PARK RD
Mailing Address - Street 2:STE. G
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2624
Mailing Address - Country:US
Mailing Address - Phone:561-487-3788
Mailing Address - Fax:561-487-3166
Practice Address - Street 1:11435 W PALMETTO PARK RD
Practice Address - Street 2:STE. G
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2624
Practice Address - Country:US
Practice Address - Phone:561-487-3788
Practice Address - Fax:561-487-3166
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3804922500Medicaid
FL22807ZMedicare ID - Type UnspecifiedMEDICARE PROVIDOR I.D.
FL3804922500Medicaid