Healthcare Provider Details

I. General information

NPI: 1740798438
Provider Name (Legal Business Name): C.O.R. INJURY CENTERS OF HOLLYWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 STIRLING RD
FORT LAUDERDALE FL
33312-6565
US

IV. Provider business mailing address

3107 STIRLING RD STE 206
FORT LAUDERDALE FL
33312-8502
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-5644
  • Fax:
Mailing address:
  • Phone: 954-835-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AILEEN MEDINA
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-835-5644