Provider Demographics
NPI:1376766865
Name:CHIROPRACTIC WELLNESS CENTER OF BOCA RATON
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF BOCA RATON
Other - Org Name:THE WELLNESS CENTER OF BOCA RATON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-417-9355
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7209
Mailing Address - Country:US
Mailing Address - Phone:561-417-9355
Mailing Address - Fax:561-417-9488
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-417-9355
Practice Address - Fax:561-417-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7638302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3278Medicare ID - Type UnspecifiedOFFICE MEDICARE NUMBER