Provider Demographics
NPI:1518510841
Name:MOBILE CHIRO REHAB, INC.
Entity Type:Organization
Organization Name:MOBILE CHIRO REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-333-2648
Mailing Address - Street 1:618 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1034
Mailing Address - Country:US
Mailing Address - Phone:954-274-0396
Mailing Address - Fax:
Practice Address - Street 1:618 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1034
Practice Address - Country:US
Practice Address - Phone:954-274-0396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty