Provider Demographics
NPI:1568707016
Name:ORTHOPEDIC AND SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-610-0048
Mailing Address - Street 1:1208 NW 144TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2927
Mailing Address - Country:US
Mailing Address - Phone:954-610-0048
Mailing Address - Fax:954-962-9857
Practice Address - Street 1:6030 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7964
Practice Address - Country:US
Practice Address - Phone:954-962-9525
Practice Address - Fax:954-962-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6934111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty