Healthcare Provider Details

I. General information

NPI: 1235872094
Provider Name (Legal Business Name): NEURO CIRCUIT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 W STATE ROAD 84 STE 208
DAVIE FL
33324-4235
US

IV. Provider business mailing address

10650 W STATE ROAD 84 STE 208
DAVIE FL
33324-4235
US

V. Phone/Fax

Practice location:
  • Phone: 954-410-2999
  • Fax:
Mailing address:
  • Phone: 954-410-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: LISA HUSEBOE
Title or Position: PD
Credential:
Phone: 954-410-2999