MEDICARE: GENESIS PAIN MANAGEMENT

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	:	1376131813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	3317 NW 10TH TER STE 406
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5941
Country	:	US
Telephone Number	:	954-990-4227
Fax Number	:	954-990-6334

Provider Business Practice Location Address
First Line	:	3317 NW 10TH TER STE 406
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-5941
Country	:	US
Telephone Number	:	954-990-4227
Fax Number	:	954-990-6334

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KENNETH ROSENBLATT
Credential	:	DC
Telephone Number	:	954-990-4227

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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Directions to “GENESIS PAIN MANAGEMENT ” Practice Location

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