Healthcare Provider Details

I. General information

NPI: 1972430072
Provider Name (Legal Business Name): HEALTHSOURCE OF SOUTH BRADENTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 14TH STREET WEST
BRADENTON FL
34205
US

IV. Provider business mailing address

11305 NW 55TH LN
DORAL FL
33178-3816
US

V. Phone/Fax

Practice location:
  • Phone: 941-866-3058
  • Fax:
Mailing address:
  • Phone: 610-937-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUNO CONTRO
Title or Position: PRESIDENT
Credential: DC
Phone: 610-937-4862