Provider Demographics
NPI:1720637218
Name:BOUTROS, ABANOUB (DC)
Entity Type:Individual
Prefix:DR
First Name:ABANOUB
Middle Name:
Last Name:BOUTROS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S DIXIE HWY UNIT 2313
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-5524
Mailing Address - Country:US
Mailing Address - Phone:561-308-7145
Mailing Address - Fax:
Practice Address - Street 1:5801 S DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-3651
Practice Address - Country:US
Practice Address - Phone:561-308-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor