Provider Demographics
NPI:1326358375
Name:MDR ADVANCED MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:MDR ADVANCED MEDICAL ASSOCIATES INC
Other - Org Name:MDR CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIROMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-731-3361
Mailing Address - Street 1:1899 N CONGRESS AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8215
Mailing Address - Country:US
Mailing Address - Phone:561-731-3361
Mailing Address - Fax:561-731-3374
Practice Address - Street 1:1899 N CONGRESS AVE STE 9
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8215
Practice Address - Country:US
Practice Address - Phone:561-731-3361
Practice Address - Fax:561-731-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty