Healthcare Provider Details

I. General information

NPI: 1851891907
Provider Name (Legal Business Name): USA SPORTS CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20754 W DIXIE HWY
MIAMI FL
33180
US

IV. Provider business mailing address

20754 W DIXIE HWY
MIAMI FL
33180-1146
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-9599
  • Fax:
Mailing address:
  • Phone: 305-935-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW COOPER
Title or Position: AUTHORIZED OFFICIAL / PROVIDER
Credential: DC
Phone: 305-978-6689