Provider Demographics
NPI:1922420884
Name:PALM BEACH MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:PALM BEACH MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-996-7272
Mailing Address - Street 1:1309 S FLAGLER DR
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6736
Mailing Address - Country:US
Mailing Address - Phone:813-995-0984
Mailing Address - Fax:813-280-6193
Practice Address - Street 1:1309 S FLAGLER DR
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6736
Practice Address - Country:US
Practice Address - Phone:813-995-0984
Practice Address - Fax:813-280-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty