Provider Demographics
NPI:1437423571
Name:BOCA PAIN RELIEF CENTER, PLLC
Entity Type:Organization
Organization Name:BOCA PAIN RELIEF CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:PASULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-483-3900
Mailing Address - Street 1:20925 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1423
Mailing Address - Country:US
Mailing Address - Phone:561-483-3900
Mailing Address - Fax:
Practice Address - Street 1:20925 LYONS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1423
Practice Address - Country:US
Practice Address - Phone:561-483-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9028111N00000X
FLME45620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGF254AMedicare PIN
FL6695350001Medicare NSC