MEDICARE: USA SPORTSCHIROPRACTIC, 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	225100000X	Physical Therapist
2	111N00000X	Chiropractor		FL

General Provider Information

NPI Number	:	1578922167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA SPORTSCHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	21000 NE 28TH AVE STE 104
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-1421
Country	:	US
Telephone Number	:	305-935-9599
Fax Number	:	305-932-5612

Provider Business Practice Location Address
First Line	:	1220 20TH ST
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139
Country	:	US
Telephone Number	:	305-935-9599
Fax Number	:	305-932-5612

Authorized Official
Title or Position	:	MANAGER
Name	:	MATTHEW COOPER
Credential	:	D.C.
Telephone Number	:	305-935-9599

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	12/08/2025

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