Provider Demographics
NPI:1104363696
Name:ALAN BRUCE DAUTCH, PA
Entity Type:Organization
Organization Name:ALAN BRUCE DAUTCH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-988-1022
Mailing Address - Street 1:2295 NW CORPORATE BLVD
Mailing Address - Street 2:#245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7373
Mailing Address - Country:US
Mailing Address - Phone:561-988-1022
Mailing Address - Fax:
Practice Address - Street 1:2832 STIRLING RD
Practice Address - Street 2:SUITES E & F
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1127
Practice Address - Country:US
Practice Address - Phone:561-988-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty