Healthcare Provider Details

I. General information

NPI: 1598023467
Provider Name (Legal Business Name): SOUTH FLORIDA PAIN & REHABILITATION OF HIALEAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 W 68TH ST STE 202/204
HIALEAH FL
33062
US

IV. Provider business mailing address

1600 S FEDERAL HWY STE 390
POMPANO BEACH FL
33062-7553
US

V. Phone/Fax

Practice location:
  • Phone: 305-818-1906
  • Fax:
Mailing address:
  • Phone: 954-942-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH8093
License Number StateFL

VIII. Authorized Official

Name: DANNY FEDER
Title or Position: PRESIDENT
Credential:
Phone: 954-942-8085