Provider Demographics
NPI:1669517173
Name:ROYAL PALM CHIROPRACTIC & REHAB CENTER P. A
Entity type:Organization
Organization Name:ROYAL PALM CHIROPRACTIC & REHAB CENTER P. A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-383-8080
Mailing Address - Street 1:3832 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1535
Mailing Address - Country:US
Mailing Address - Phone:561-627-9696
Mailing Address - Fax:561-627-6925
Practice Address - Street 1:3832 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1535
Practice Address - Country:US
Practice Address - Phone:561-627-9696
Practice Address - Fax:561-627-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70798ZMedicare ID - Type UnspecifiedMEDICARE
FL70790ZMedicare ID - Type UnspecifiedMEDICARE