MEDICARE: PALM BEACH SPORTS REHAB & MEDICAL CENTERS 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

General Provider Information

NPI Number	:	1255566535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH SPORTS REHAB & MEDICAL CENTERS INC

Provider Business Mailing Address
First Line	:	1100 S MAIN ST
Second Line	:
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-4910
Country	:	US
Telephone Number	:	561-996-4242
Fax Number	:	561-784-3911

Provider Business Practice Location Address
First Line	:	326 GAZETTA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1052
Country	:	US
Telephone Number	:	561-996-4242
Fax Number	:	561-784-3911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER F SOTO
Credential	:	DC
Telephone Number	:	561-996-4242

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	05/15/2009

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