Healthcare Provider Details

I. General information

NPI: 1578498580
Provider Name (Legal Business Name): MR. BRIAN PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 S UNIVERSITY DR
DAVIE FL
33328-6107
US

IV. Provider business mailing address

5810 S UNIVERSITY DR
DAVIE FL
33328-6107
US

V. Phone/Fax

Practice location:
  • Phone: 954-479-8647
  • Fax:
Mailing address:
  • Phone: 954-479-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: