Provider Demographics
NPI:1831387570
Name:WOOLBRIGHT SPINE & REHAB INC
Entity type:Organization
Organization Name:WOOLBRIGHT SPINE & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:AIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-739-5393
Mailing Address - Street 1:2309 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6366
Mailing Address - Country:US
Mailing Address - Phone:561-739-5393
Mailing Address - Fax:561-369-5960
Practice Address - Street 1:2309 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE #5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6366
Practice Address - Country:US
Practice Address - Phone:561-739-5393
Practice Address - Fax:561-369-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70204ZMedicare PIN