Healthcare Provider Details

I. General information

NPI: 1720055593
Provider Name (Legal Business Name): KEITH SCOTT BRICKELL DC DACBSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 N FEDERAL HWY 121
FORT LAUDERDALE FL
33308
US

IV. Provider business mailing address

5975 N FEDERAL HWY 121
FORT LAUDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-3800
  • Fax: 954-351-0867
Mailing address:
  • Phone: 954-771-3800
  • Fax: 954-351-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0005087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: