Provider Demographics
NPI:1174753214
Name:ELITE REHABILITATION SERVICE CENTER
Entity type:Organization
Organization Name:ELITE REHABILITATION SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:561-585-0040
Mailing Address - Street 1:2125 10TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-585-0040
Mailing Address - Fax:561-585-0043
Practice Address - Street 1:2125 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3349
Practice Address - Country:US
Practice Address - Phone:561-585-0040
Practice Address - Fax:561-585-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty