MEDICARE: MARGATE PAIN & REHABILITATION 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	CH8093	FL

General Provider Information

NPI Number	:	1790043487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGATE PAIN & REHABILITATION INC

Provider Business Mailing Address
First Line	:	1600 S FEDERAL HWY STE 390
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7553
Country	:	US
Telephone Number	:	954-942-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	6890 W ATLANTIC BLVD
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5045
Country	:	US
Telephone Number	:	954-917-1200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANNY S FEDER
Credential	:	DC
Telephone Number	:	954-942-8085

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/01/2012

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