Healthcare Provider Details

I. General information

NPI: 1578951893
Provider Name (Legal Business Name): BRIAN ESCHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N OLEANDER AVE
DAYTONA BEACH FL
32118-3115
US

IV. Provider business mailing address

2700 N OLEANDER AVE
DAYTONA BEACH FL
32118-3115
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-4674
  • Fax: 386-506-5054
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: