Provider Demographics
NPI:1154196202
Name:MEDX BACK PAIN CLINICS. INC.
Entity type:Organization
Organization Name:MEDX BACK PAIN CLINICS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-727-8995
Mailing Address - Street 1:11951 US HIGHWAY 1 STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2804
Mailing Address - Country:US
Mailing Address - Phone:561-727-8995
Mailing Address - Fax:
Practice Address - Street 1:11951 US HIGHWAY 1 STE 105
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2804
Practice Address - Country:US
Practice Address - Phone:561-727-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty