Provider Demographics
NPI:1891029294
Name:ATLANTIC GROVE CHIROPRACTIC & REHABILITATION, INC.
Entity Type:Organization
Organization Name:ATLANTIC GROVE CHIROPRACTIC & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:HESSAM
Authorized Official - Last Name:KHATAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-455-4850
Mailing Address - Street 1:7815 NW BEACON SQUARE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1345
Mailing Address - Country:US
Mailing Address - Phone:561-455-4850
Mailing Address - Fax:561-995-0138
Practice Address - Street 1:7815 NW BEACON SQUARE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1345
Practice Address - Country:US
Practice Address - Phone:561-455-4850
Practice Address - Fax:561-995-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty