Provider Demographics
NPI:1225041015
Name:COHEN, MICHAEL I I (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:COHEN
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1657
Mailing Address - Country:US
Mailing Address - Phone:954-537-5558
Mailing Address - Fax:954-537-7997
Practice Address - Street 1:2631 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1657
Practice Address - Country:US
Practice Address - Phone:954-537-5558
Practice Address - Fax:954-537-7997
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL589-7905OtherGHI
FL21195294748OtherBEECH STREET
FL3815315 00Medicaid
FL21195294748OtherBEECH STREET