Healthcare Provider Details

I. General information

NPI: 1578922167
Provider Name (Legal Business Name): USA SPORTSCHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 PAN AMERICAN DR
COCONUT GROVE FL
33133-5510
US

IV. Provider business mailing address

21150 BISCAYNE BLVD STE 406
AVENTURA FL
33180-1250
US

V. Phone/Fax

Practice location:
  • Phone: 305-735-3508
  • Fax: 786-329-7460
Mailing address:
  • Phone: 305-935-9599
  • Fax: 305-932-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW COOPER
Title or Position: MANAGER
Credential: D.C.
Phone: 305-935-9599