Healthcare Provider Details

I. General information

NPI: 1487873477
Provider Name (Legal Business Name): FLORIDA CHIROPRACTIC AND SPORTS REHAB CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20754 W DIXIE HWY
MIAMI FL
33180-1146
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: 305-932-5612
Mailing address:
  • Phone: 305-935-9599
  • Fax: 305-932-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH7801
License Number StateFL

VIII. Authorized Official

Name: DR. MATTHEW IAN COOPER
Title or Position: OWNER
Credential: DC
Phone: 305-935-9599