=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619163482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHAB CLINICS OF AMERICA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2007
-----------------------------------------------------
Last Update Date | 09/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 E NEW YORK AVE SUITE 8
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32724-6083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-734-3795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3651 PEACHTREE PKWY SUITE E #312
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-791-1916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. CHARLES ANNUNZIATA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 856-275-1325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH9417
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------