Basic Information
| Provider Information | |||||||||
| NPI: | 1801041686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL PALM BEACH MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617919090 | ||||||||
| FaxNumber: | 5617919071 | ||||||||
| Practice Location | |||||||||
| Address1: | 762 S FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334415767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543790300 | ||||||||
| FaxNumber: | 9543790301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5618012535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NR0400X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Rehabilitation | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.