Provider Demographics
NPI:1578922167
Name:USA SPORTSCHIROPRACTIC, INC
Entity Type:Organization
Organization Name:USA SPORTSCHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-935-9599
Mailing Address - Street 1:21000 NE 28TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1421
Mailing Address - Country:US
Mailing Address - Phone:305-935-9599
Mailing Address - Fax:305-932-5612
Practice Address - Street 1:1220 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-935-9599
Practice Address - Fax:305-932-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty