Provider Demographics
NPI:1992063689
Name:SOUTH FLORIDA PAIN & REHABILITAITON CENTER CORP
Entity type:Organization
Organization Name:SOUTH FLORIDA PAIN & REHABILITAITON CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-942-8085
Mailing Address - Street 1:1600 S FEDERAL HWY STE 390
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7553
Mailing Address - Country:US
Mailing Address - Phone:954-942-8085
Mailing Address - Fax:
Practice Address - Street 1:16244 S MILITARY TRL STE 470
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6532
Practice Address - Country:US
Practice Address - Phone:561-637-3779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8093111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty