MEDICARE: SOUTH FLORIDA THERAPY AND WELLNESS CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6211	FL

General Provider Information

NPI Number	:	1053619833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA THERAPY AND WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	800 E CYPRESS CREEK RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-3522
Country	:	US
Telephone Number	:	954-605-2737
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E CYPRESS CREEK RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-3522
Country	:	US
Telephone Number	:	954-605-2737
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MR. GARY BOFSHEVER
Credential	:	DC
Telephone Number	:	954-605-2737

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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