MEDICARE: AVENTURA WELLNESS AND REHAB CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	501515-1	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083815286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENTURA WELLNESS AND REHAB CENTER, INC.

Provider Business Mailing Address
First Line	:	2440 NE MIAMI GARDENS DR
Second Line	:	SUITE 101
City	:	AVENTURA
State	:	FL
Zip	:	33180-2734
Country	:	US
Telephone Number	:	305-705-0777
Fax Number	:	305-705-9978

Provider Business Practice Location Address
First Line	:	2440 NE MIAMI GARDENS DR
Second Line	:	SUITE 101
City	:	AVENTURA
State	:	FL
Zip	:	33180-2734
Country	:	US
Telephone Number	:	305-705-0777
Fax Number	:	305-705-9978

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	BERNARD A. GREAUX
Credential	:	D.C.
Telephone Number	:	305-705-0777

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	09/07/2012

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