Provider Demographics
NPI:1760766380
Name:SHADOWOOD CHIROPRACTIC CENTER,INC.
Entity Type:Organization
Organization Name:SHADOWOOD CHIROPRACTIC CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELLABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-488-4000
Mailing Address - Street 1:9799 GLADES RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3916
Mailing Address - Country:US
Mailing Address - Phone:561-488-4000
Mailing Address - Fax:561-488-4116
Practice Address - Street 1:9799 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3916
Practice Address - Country:US
Practice Address - Phone:561-488-4000
Practice Address - Fax:561-488-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70958OtherMEDICARE PTAN