MEDICARE: SOUTH FLORIDA REHAB & SPA

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	CH8464	FL

General Provider Information

NPI Number	:	1740453745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA REHAB & SPA

Provider Business Mailing Address
First Line	:	3940 METRO PKWY
Second Line	:	SUITE 105
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9485
Country	:	US
Telephone Number	:	239-936-9936
Fax Number	:	239-936-9937

Provider Business Practice Location Address
First Line	:	3940 METRO PKWY
Second Line	:	SUITE 105
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9485
Country	:	US
Telephone Number	:	239-936-9936
Fax Number	:	239-936-9937

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW ANDONOV
Credential	:	DC,MS, FABCS
Telephone Number	:	239-936-9936

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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