MEDICARE: MR. GREGG R POPKIN D.C.

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	CH-7081	FL

General Provider Information

NPI Number	:	1639218993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGG R POPKIN D.C.

Provider Business Mailing Address
First Line	:	4631 NW 31ST AVE
Second Line	:	#135
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3433
Country	:	US
Telephone Number	:	954-486-1377
Fax Number	:	954-486-1374

Provider Business Practice Location Address
First Line	:	4384 NW 31ST AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-4206
Country	:	US
Telephone Number	:	954-486-1377
Fax Number	:	943-486-1374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/26/2012

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