Provider Demographics
NPI:1245209287
Name:SF CHIROPRACTIC & REHAB CENTER, INC
Entity Type:Organization
Organization Name:SF CHIROPRACTIC & REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:813-350-9100
Mailing Address - Street 1:4121 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6433
Mailing Address - Country:US
Mailing Address - Phone:813-350-9100
Mailing Address - Fax:813-374-8929
Practice Address - Street 1:2312 CRESTOVER LN STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6790
Practice Address - Country:US
Practice Address - Phone:813-501-8091
Practice Address - Fax:813-803-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9101111N00000X, 111N00000X
FLCH6830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98012OtherBCBS FLORIDA
FL0007183804OtherATENA
FL698090OtherUNITED HEALTH CARE
FL98012OtherBCBS FLORIDA
FL031375100Medicaid
FL0007183804OtherATENA