Provider Demographics
NPI:1124371414
Name:TOTAL HEALTH AND REHAB OF DELRAY BEACH LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH AND REHAB OF DELRAY BEACH LLC
Other - Org Name:TOTAL HEALTH AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MINETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-350-8689
Mailing Address - Street 1:PO BOX 970499
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097-0499
Mailing Address - Country:US
Mailing Address - Phone:561-350-8689
Mailing Address - Fax:561-482-7724
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:561-350-8689
Practice Address - Fax:561-482-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7498111N00000X
FLCH10244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty