MEDICARE: CHARLES SROUR DC

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	CH8667	FL

General Provider Information

NPI Number	:	1396741559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES SROUR DC

Provider Business Mailing Address
First Line	:	1948 NE 123RD ST
Second Line	:	STE 107
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2800
Country	:	US
Telephone Number	:	305-891-2520
Fax Number	:	305-891-5754

Provider Business Practice Location Address
First Line	:	1948 NE 123RD ST
Second Line	:	STE 107
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2800
Country	:	US
Telephone Number	:	305-891-2520
Fax Number	:	305-891-5754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	05/08/2008

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Directions to “ CHARLES SROUR DC” Practice Location

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