Provider Demographics
NPI:1619941234
Name:MOTE, DAVID RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:MOTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4500
Mailing Address - Country:US
Mailing Address - Phone:561-742-3283
Mailing Address - Fax:561-742-3280
Practice Address - Street 1:3111 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4500
Practice Address - Country:US
Practice Address - Phone:561-742-3283
Practice Address - Fax:561-742-3280
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380849100Medicaid
FL22533OtherBLUE CROSS BLUE SHIELD
FL603595500OtherOWCP
FL22533OtherBLUE CROSS BLUE SHIELD
FL603595500OtherOWCP