=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366563025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM-AIRE MEDICAL & REHAB CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 E COMMERCIAL BLVD
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334-5737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-489-2200
-----------------------------------------------------
Fax | 954-489-2216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2706 W ATLANTIC BLVD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-957-7500
-----------------------------------------------------
Fax | 954-957-7040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS MORE MANIDIS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 954-489-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8425
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------