Provider Demographics
NPI:1649509159
Name:HOLLYWOOD MEDICAL AND PAIN CENTER LLC
Entity type:Organization
Organization Name:HOLLYWOOD MEDICAL AND PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-962-9525
Mailing Address - Street 1:5100 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6518
Mailing Address - Country:US
Mailing Address - Phone:954-962-9525
Mailing Address - Fax:954-962-9857
Practice Address - Street 1:5100 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6518
Practice Address - Country:US
Practice Address - Phone:954-962-9525
Practice Address - Fax:954-962-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty