MEDICARE: ADVANTAGE REHABILITATION & WELLNESS CENTER II, 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

General Provider Information

NPI Number	:	1508018839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE REHABILITATION & WELLNESS CENTER II, LLC

Provider Business Mailing Address
First Line	:	1145 19TH ST NW
Second Line	:	SUITE 501
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3701
Country	:	US
Telephone Number	:	202-835-2225
Fax Number	:	202-835-2040

Provider Business Practice Location Address
First Line	:	641 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4303
Country	:	US
Telephone Number	:	202-293-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RASHIDA COHEN
Credential	:	DC
Telephone Number	:	202-835-2225

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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