Healthcare Provider Details

I. General information

NPI: 1679873939
Provider Name (Legal Business Name): BRICKELL CHIROPRACTIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 N FEDERAL HWY 121
FT LAUDERDALE FL
33308-2690
US

IV. Provider business mailing address

5975 NOTH FEDERAL HWY 121
FT LAUDERDALE FL
33308-2661
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 Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5087
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH SCOTT BRICKELL
Title or Position: PRESIDENT
Credential: D.C.,DACBSP
Phone: 954-771-3800