Provider Demographics
NPI:1972789964
Name:COMPLETE REHAB & MEDICAL CENTER OF WEST PALM BEACH
Entity Type:Organization
Organization Name:COMPLETE REHAB & MEDICAL CENTER OF WEST PALM BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-818-8283
Mailing Address - Street 1:PO BOX 741235
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-1235
Mailing Address - Country:US
Mailing Address - Phone:561-682-9383
Mailing Address - Fax:
Practice Address - Street 1:4935 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4629
Practice Address - Country:US
Practice Address - Phone:561-682-9383
Practice Address - Fax:567-682-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7924111N00000X
FLCH5093111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid