MEDICARE: INJURY CLINC & REHAB CENTER

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	111NI0013X	Independent Medical Examiner Chiropractor	CH9798	FL

General Provider Information

NPI Number	:	1245615343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY CLINC & REHAB CENTER

Provider Business Mailing Address
First Line	:	1229 NORTH MILITARY TRAIL #6
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6059
Country	:	US
Telephone Number	:	561-687-5150
Fax Number	:	561-687-5051

Provider Business Practice Location Address
First Line	:	1229 NORTH MILITARY TRAIL #6
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6059
Country	:	US
Telephone Number	:	561-687-5150
Fax Number	:	561-687-5051

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. AYAL GOLDSTEIN
Credential	:	D.C.
Telephone Number	:	561-687-5150

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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