Provider Demographics
NPI:1720463383
Name:BOCA CHIROPRACTIC SPINE & INJURY CENTER LLC
Entity Type:Organization
Organization Name:BOCA CHIROPRACTIC SPINE & INJURY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-929-5600
Mailing Address - Street 1:2300 GLADES RD
Mailing Address - Street 2:SUITE 430W
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7386
Mailing Address - Country:US
Mailing Address - Phone:561-929-5600
Mailing Address - Fax:
Practice Address - Street 1:2300 GLADES RD
Practice Address - Street 2:SUITE 430W
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7386
Practice Address - Country:US
Practice Address - Phone:561-929-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty