Provider Demographics
NPI:1114003845
Name:CENTER FOR BACK PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:CENTER FOR BACK PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-737-1947
Mailing Address - Street 1:8188 JOG RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2952
Mailing Address - Country:US
Mailing Address - Phone:561-737-1947
Mailing Address - Fax:561-737-9074
Practice Address - Street 1:8188 JOG RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2952
Practice Address - Country:US
Practice Address - Phone:561-737-1947
Practice Address - Fax:561-737-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty