Healthcare Provider Details

I. General information

NPI: 1033365770
Provider Name (Legal Business Name): DR DAVID BASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6621
US

IV. Provider business mailing address

9737 NW 65TH PL
PARKLAND FL
33076-2315
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-4045
  • Fax:
Mailing address:
  • Phone: 954-649-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH3178
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID B BASS
Title or Position: PRESIDENT
Credential: DC, AP
Phone: 954-649-6540