Healthcare Provider Details

I. General information

NPI: 1003096207
Provider Name (Legal Business Name): SOUTH FLORIDA CHIROPRACTIC & REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 W. CAMINO GARDENS BLVD SUITE 103
BOCA RATON FL
33432-5822
US

IV. Provider business mailing address

299 W. CAMINO GARDENS BLVD SUITE 103
BOCA RATON FL
33432-5822
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-9299
  • Fax: 561-395-7995
Mailing address:
  • Phone: 561-395-9299
  • Fax: 561-395-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8413
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME37335
License Number StateFL

VIII. Authorized Official

Name: MRS. NATALIA FANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-395-9299