Healthcare Provider Details

I. General information

NPI: 1396035655
Provider Name (Legal Business Name): BRANDON BACK PAIN RELIEF CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E BLOOMINGDALE AVE STE B
BRANDON FL
33511-8101
US

IV. Provider business mailing address

166 E BLOOMINGDALE AVE STE B
BRANDON FL
33511-8101
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-7121
  • Fax: 813-200-3986
Mailing address:
  • Phone: 813-654-7121
  • Fax: 813-200-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD F POLLEY
Title or Position: OWNER
Credential: D.C.
Phone: 813-654-7121