Provider Demographics
NPI:1477617660
Name:UNITED MEDICAL CENTER OF BOCA RATON CORP
Entity Type:Organization
Organization Name:UNITED MEDICAL CENTER OF BOCA RATON CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEIDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-477-8081
Mailing Address - Street 1:22023 STATE ROAD 7
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3401
Mailing Address - Country:US
Mailing Address - Phone:561-477-8081
Mailing Address - Fax:561-477-9280
Practice Address - Street 1:22023 STATE ROAD 7
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3401
Practice Address - Country:US
Practice Address - Phone:561-477-8081
Practice Address - Fax:561-477-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBN179AMedicare PIN