Provider Demographics
NPI:1962599902
Name:HILLSBORO PAIN & REHAB CENTER
Entity type:Organization
Organization Name:HILLSBORO PAIN & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VANDERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-428-2729
Mailing Address - Street 1:2247 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1106
Mailing Address - Country:US
Mailing Address - Phone:954-428-2729
Mailing Address - Fax:954-428-2794
Practice Address - Street 1:2247 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1106
Practice Address - Country:US
Practice Address - Phone:954-428-2729
Practice Address - Fax:954-428-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76949AMedicare ID - Type Unspecified