Provider Demographics
NPI:1700178415
Name:MAX REHAB & CHIROPRACTIC CENTER CORP
Entity Type:Organization
Organization Name:MAX REHAB & CHIROPRACTIC CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-673-7012
Mailing Address - Street 1:1224 DEL PRADO BLVD S STE C
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3670
Mailing Address - Country:US
Mailing Address - Phone:239-673-7012
Mailing Address - Fax:239-673-7013
Practice Address - Street 1:1224 DEL PRADO BLVD S STE C
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3670
Practice Address - Country:US
Practice Address - Phone:239-673-7012
Practice Address - Fax:239-673-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty