Provider Demographics
NPI:1326344433
Name:WEST BROWARD WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:WEST BROWARD WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYZOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAHDAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-474-3919
Mailing Address - Street 1:6736 N. UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4013
Mailing Address - Country:US
Mailing Address - Phone:954-474-3919
Mailing Address - Fax:954-474-1799
Practice Address - Street 1:6736 N. UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4013
Practice Address - Country:US
Practice Address - Phone:954-474-3919
Practice Address - Fax:954-474-1799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST BROWARD WELLNESS CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380174800Medicaid
FL380174800Medicaid
FLU20129Medicare UPIN