Provider Demographics
NPI:1902341993
Name:MELBOURNE CHIROPRACTIC, WELLNESS & REHAB, LLC
Entity Type:Organization
Organization Name:MELBOURNE CHIROPRACTIC, WELLNESS & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROZANA
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-802-1252
Mailing Address - Street 1:1103 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2714
Mailing Address - Country:US
Mailing Address - Phone:321-802-1252
Mailing Address - Fax:844-231-8920
Practice Address - Street 1:1103 W HIBISCUS BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2714
Practice Address - Country:US
Practice Address - Phone:321-802-1252
Practice Address - Fax:844-231-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty