MEDICARE: TAMPA CHIROPRACTIC AND REHAB 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	261QR0400X	Rehabilitation Clinic/Center	CH 8456	FL

General Provider Information

NPI Number	:	1134307291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA CHIROPRACTIC AND REHAB CENTER INC.

Provider Business Mailing Address
First Line	:	4023 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1017
Country	:	US
Telephone Number	:	813-801-9001
Fax Number	:	813-801-9007

Provider Business Practice Location Address
First Line	:	4023 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1017
Country	:	US
Telephone Number	:	813-801-9001
Fax Number	:	813-801-9007

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELLIOT MARCIAL RIVERA
Credential	:	D.C
Telephone Number	:	813-801-9001

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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