MEDICARE: MIAMI FAMILY CHIROPRACTIC 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1679750269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI FAMILY CHIROPRACTIC CENTER INC.

Provider Business Mailing Address
First Line	:	4305 E 8TH AVE
Second Line	:	SUITE # C
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	305-681-2268
Fax Number	:	305-681-2264

Provider Business Practice Location Address
First Line	:	4305 E 8TH AVE
Second Line	:	SUITE # C
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	305-681-2268
Fax Number	:	305-681-2264

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN KARL REISECK SR.
Credential	:	DC
Telephone Number	:	305-681-2268

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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