Provider Demographics
NPI:1750459087
Name:DEERFIELD BOCA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DEERFIELD BOCA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:KIRSCHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-428-7500
Mailing Address - Street 1:36 NE 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEECH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-428-7500
Mailing Address - Fax:954-428-7502
Practice Address - Street 1:36 NE 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEECH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:954-428-7500
Practice Address - Fax:954-428-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050667200Medicaid
T84449Medicare UPIN
FL38715Medicare ID - Type Unspecified