Provider Demographics
NPI:1437426137
Name:FIRST CHIRO REHAB CENTER INC
Entity Type:Organization
Organization Name:FIRST CHIRO REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-674-9437
Mailing Address - Street 1:3507 LEE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1303
Mailing Address - Country:US
Mailing Address - Phone:239-674-9437
Mailing Address - Fax:239-674-9524
Practice Address - Street 1:3507 LEE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1303
Practice Address - Country:US
Practice Address - Phone:239-674-9437
Practice Address - Fax:239-674-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6781261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy