MEDICARE: SOUTHERN SPINAL REHAB, 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
2	225100000X	Physical Therapist
3	111N00000X	Chiropractor	6329	FL

General Provider Information

NPI Number	:	1396994133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SPINAL REHAB, LLC

Provider Business Mailing Address
First Line	:	91 W HOOD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-3019
Country	:	US
Telephone Number	:	850-475-4227
Fax Number	:	850-475-8200

Provider Business Practice Location Address
First Line	:	91 W HOOD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-3019
Country	:	US
Telephone Number	:	850-475-4227
Fax Number	:	850-475-8200

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	DR. STEPHEN B HAAS
Credential	:	D.C.
Telephone Number	:	850-475-4227

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	03/17/2009

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