MEDICARE: INFINITE LIFE MEDICAL LLC

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	CH0007996	FL

General Provider Information

NPI Number	:	1376822353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE LIFE MEDICAL LLC

Provider Business Mailing Address
First Line	:	2126 N FLAMINGO RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-3501
Country	:	US
Telephone Number	:	954-437-6660
Fax Number	:	954-450-2252

Provider Business Practice Location Address
First Line	:	2126 N FLAMINGO RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-3501
Country	:	US
Telephone Number	:	954-437-6660
Fax Number	:	954-450-2252

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SHELDON M GOLDBERG
Credential	:
Telephone Number	:	954-437-6660

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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