=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902846363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCLEPIUS MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5455 SW 8TH ST SUITE 210
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-441-8781
-----------------------------------------------------
Fax | 305-441-8782
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5455 SW 8TH ST
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-441-8781
-----------------------------------------------------
Fax | 305-441-8782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MIGUEL BETANCOURT
-----------------------------------------------------
Credential | CHIROPRACTOR PHYSICI
-----------------------------------------------------
Telephone | 305-441-8781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 440084-2
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------