MEDICARE: MS. BREANNA IRENE KUSSY 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	CH12037	FL

General Provider Information

NPI Number	:	1588177760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BREANNA IRENE KUSSY DC

Provider Business Mailing Address
First Line	:	235 3RD AVE N UNIT 209
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-3356
Country	:	US
Telephone Number	:	727-403-2287
Fax Number	:

Provider Business Practice Location Address
First Line	:	3157 4TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-2124
Country	:	US
Telephone Number	:	727-403-2287
Fax Number	:

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	11/10/2017

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