MEDICARE: ORTHOPEDIC AND SURGERY CENTER LLC

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	CH6934	FL

General Provider Information

NPI Number	:	1568707016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1208 NW 144TH TER
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2927
Country	:	US
Telephone Number	:	954-610-0048
Fax Number	:	954-962-9857

Provider Business Practice Location Address
First Line	:	6030 HOLLYWOOD BLVD
Second Line	:	SUITE 250
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-7964
Country	:	US
Telephone Number	:	954-962-9525
Fax Number	:	954-962-9857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS HOWARD BONNEAU
Credential	:	DC
Telephone Number	:	954-610-0048

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	12/10/2012

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