MEDICARE: BREANNA DIEHL HOLM DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12614	FL

General Provider Information

NPI Number	:	1548737174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA DIEHL HOLM DC

Provider Business Mailing Address
First Line	:	4178 CENTRAL SARASOTA PKWY APT 335
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-6624
Country	:	US
Telephone Number	:	715-209-7416
Fax Number	:

Provider Business Practice Location Address
First Line	:	4678 FRUITVILLE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-1825
Country	:	US
Telephone Number	:	941-379-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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Directions to “ BREANNA DIEHL HOLM DC” Practice Location

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