Provider Demographics
NPI:1801138375
Name:ABUNDANCE SPA AND REHAB, INC
Entity type:Organization
Organization Name:ABUNDANCE SPA AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-857-2900
Mailing Address - Street 1:3650 SW 10TH ST
Mailing Address - Street 2:1-B
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-5997
Mailing Address - Country:US
Mailing Address - Phone:954-857-2900
Mailing Address - Fax:954-857-2901
Practice Address - Street 1:3650 SW 10TH ST
Practice Address - Street 2:1-B
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-5997
Practice Address - Country:US
Practice Address - Phone:954-857-2900
Practice Address - Fax:954-857-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9589111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty