Provider Demographics
NPI:1477675999
Name:NORTHWEST CENTER FOR INTEGRATIVE MEDICINE AND REHABILITATION
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR INTEGRATIVE MEDICINE AND REHABILITATION
Other - Org Name:NCI MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-977-9077
Mailing Address - Street 1:2960 N STATE ROAD 7
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5755
Mailing Address - Country:US
Mailing Address - Phone:954-977-9077
Mailing Address - Fax:954-979-0675
Practice Address - Street 1:2960 N STATE ROAD 7
Practice Address - Street 2:SUITE 204
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5755
Practice Address - Country:US
Practice Address - Phone:954-977-9077
Practice Address - Fax:954-979-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004917111NN1001X
FLCH0006667111NN1001X
FLAP1704171100000X
FLAP1605171100000X
FLME27172204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3811301-00Medicaid
FL3811301-00Medicaid
FLK5273Medicare PIN