Provider Demographics
NPI:1568559706
Name:SOUTH FLORIDA REHABILITATION & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA REHABILITATION & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:DR
Authorized Official - First Name:AIXA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-271-7447
Mailing Address - Street 1:7990 SW 117TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3847
Mailing Address - Country:US
Mailing Address - Phone:305-271-7447
Mailing Address - Fax:305-271-7448
Practice Address - Street 1:7990 SW 117TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3847
Practice Address - Country:US
Practice Address - Phone:305-271-7447
Practice Address - Fax:305-271-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34529Medicare ID - Type Unspecified