Provider Demographics
NPI:1851439426
Name:MDM CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MDM CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-272-0388
Mailing Address - Street 1:1000 LINTON BLVD
Mailing Address - Street 2:SUITE A7
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1123
Mailing Address - Country:US
Mailing Address - Phone:561-272-0388
Mailing Address - Fax:561-272-0498
Practice Address - Street 1:5768 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4343
Practice Address - Country:US
Practice Address - Phone:561-697-8787
Practice Address - Fax:561-272-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22745Medicare ID - Type Unspecified
FLU30177Medicare UPIN