Provider Demographics
NPI:1003096207
Name:SOUTH FLORIDA CHIROPRACTIC & REHABILITATION INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA CHIROPRACTIC & REHABILITATION INC
Other - Org Name:BOCA SPINE & WELLNESS CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-395-9299
Mailing Address - Street 1:299 W. CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5822
Mailing Address - Country:US
Mailing Address - Phone:561-395-9299
Mailing Address - Fax:561-395-7995
Practice Address - Street 1:299 W. CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5822
Practice Address - Country:US
Practice Address - Phone:561-395-9299
Practice Address - Fax:561-395-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8413111N00000X
FLME37335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79651OtherBCBS PIN
FL93982DMedicare PIN
FLE14554Medicare UPIN
FLU95255Medicare UPIN
FL79651YMedicare PIN