=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902443575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASTER CHIROPRACTIC & REHAB CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2019
-----------------------------------------------------
Last Update Date | 01/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7392 NW 35TH TER STE 309
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-631-4976
-----------------------------------------------------
Fax | 786-633-5185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7392 NW 35TH TER STE 310
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-631-4976
-----------------------------------------------------
Fax | 786-633-5185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DOCTOR
-----------------------------------------------------
Name | YOENNY FABELO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 786-376-3658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------