Provider Demographics
NPI:1669481727
Name:BACK TO HEALTH OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:BACK TO HEALTH OF SOUTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-394-8770
Mailing Address - Street 1:301 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5823
Mailing Address - Country:US
Mailing Address - Phone:561-394-8770
Mailing Address - Fax:561-394-3615
Practice Address - Street 1:301 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5823
Practice Address - Country:US
Practice Address - Phone:561-394-8770
Practice Address - Fax:561-394-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4955Medicare ID - Type Unspecified