Provider Demographics
NPI:1245540806
Name:BROTH SPINE AND REHABILITATION CENTERS, LLC
Entity type:Organization
Organization Name:BROTH SPINE AND REHABILITATION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-415-5586
Mailing Address - Street 1:902 SW LOST RIVER SHORES DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7449
Mailing Address - Country:US
Mailing Address - Phone:908-415-5586
Mailing Address - Fax:772-221-1682
Practice Address - Street 1:727 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5242
Practice Address - Country:US
Practice Address - Phone:561-904-6066
Practice Address - Fax:561-904-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty