Provider Demographics
NPI:1285820027
Name:WEST HOLLYWOOD PAIN AND REHABILITATION,INC
Entity Type:Organization
Organization Name:WEST HOLLYWOOD PAIN AND REHABILITATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-466-5665
Mailing Address - Street 1:1814 NE MIAMI GARDENS DR # 906
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5043
Mailing Address - Country:US
Mailing Address - Phone:305-466-5665
Mailing Address - Fax:305-466-8580
Practice Address - Street 1:6670 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4011
Practice Address - Country:US
Practice Address - Phone:954-986-4747
Practice Address - Fax:954-986-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty