MEDICARE: SOUTH FLORIDA REHABILITATION & WELLNESS CENTER, INC

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	111NR0400X	Rehabilitation Chiropractor		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568559706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA REHABILITATION & WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	7990 SW 117TH AVE
Second Line	:	SUITE 205
City	:	MIAMI
State	:	FL
Zip	:	33183-3847
Country	:	US
Telephone Number	:	305-271-7447
Fax Number	:	305-271-7448

Provider Business Practice Location Address
First Line	:	7990 SW 117TH AVE
Second Line	:	SUITE 205
City	:	MIAMI
State	:	FL
Zip	:	33183-3847
Country	:	US
Telephone Number	:	305-271-7447
Fax Number	:	305-271-7448

Authorized Official
Title or Position	:	P
Name	:	DR. AIXA GOODRICH
Credential	:	DC
Telephone Number	:	305-271-7447

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	04/09/2012

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