Provider Demographics
NPI:1649270760
Name:BIRNBAUM, DEBRA L (DC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S FEDERAL HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4939
Mailing Address - Country:US
Mailing Address - Phone:561-731-0041
Mailing Address - Fax:561-737-7088
Practice Address - Street 1:112 S FEDERAL HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4939
Practice Address - Country:US
Practice Address - Phone:561-731-0041
Practice Address - Fax:561-737-7088
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380889100Medicaid
55398OtherBCBS
FL380889100Medicaid
FL55398ZMedicare PIN