MEDICARE: SUPERIOR INJURY CARE, 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

General Provider Information

NPI Number	:	1609103225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR INJURY CARE, INC.

Provider Business Mailing Address
First Line	:	1412 W WATERS AVE SUITE 204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 W WATERS AVE SUITE 204
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604
Country	:	US
Telephone Number	:	813-935-8784
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	EUGENIO CARCASSES
Credential	:
Telephone Number	:	813-935-8784

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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