Provider Demographics
NPI:1558656322
Name:COHEN, MAX AVERY (DC)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:AVERY
Last Name:COHEN
Suffix:
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 1:12160 S SHORE BLVD
Mailing Address - Street 2:#108
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6269
Mailing Address - Country:US
Mailing Address - Phone:561-385-8978
Mailing Address - Fax:
Practice Address - Street 1:12160 S SHORE BLVD
Practice Address - Street 2:#108
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6269
Practice Address - Country:US
Practice Address - Phone:561-385-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor