Healthcare Provider Details

I. General information

NPI: 1609127067
Provider Name (Legal Business Name): HEALTH SOLUTIONS OF BRANDON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S PARSONS AVE
BRANDON FL
33511-6063
US

IV. Provider business mailing address

807 S PARSONS AVE
BRANDON FL
33511-6063
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-8041
  • Fax: 813-689-1140
Mailing address:
  • Phone: 813-684-8041
  • Fax: 813-689-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH A WETHERINGTON
Title or Position: OWNER
Credential: D.C.
Phone: 813-684-8141