MEDICARE: OMEGA MEDICAL CENTER

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	111NR0400X	Rehabilitation Chiropractor	CH 4051	FL

General Provider Information

NPI Number	:	1063658177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4355 W 16TH AVE
Second Line	:	SUITE# 212
City	:	HIALEAH
State	:	FL
Zip	:	33012-7666
Country	:	US
Telephone Number	:	305-364-1104
Fax Number	:	305-364-1103

Provider Business Practice Location Address
First Line	:	4355 W 16TH AVE
Second Line	:	SUITE# 212
City	:	HIALEAH
State	:	FL
Zip	:	33012-7666
Country	:	US
Telephone Number	:	305-364-1104
Fax Number	:	305-364-1103

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN ROMANO
Credential	:	DC
Telephone Number	:	305-364-1104

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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Directions to “OMEGA MEDICAL CENTER ” Practice Location

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