Provider Demographics
NPI:1205682655
Name:RESTORE HEALTH GROUP S-CORP
Entity type:Organization
Organization Name:RESTORE HEALTH GROUP S-CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:647-402-0303
Mailing Address - Street 1:1320 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-3212
Mailing Address - Country:US
Mailing Address - Phone:647-402-0303
Mailing Address - Fax:
Practice Address - Street 1:10935 SE 177TH PL STE 206
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8971
Practice Address - Country:US
Practice Address - Phone:647-402-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty