Healthcare Provider Details

I. General information

NPI: 1558271023
Provider Name (Legal Business Name): VICTORY SPINAL CARE BREVARD COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W FEE AVE STE 102
MELBOURNE FL
32901-4145
US

IV. Provider business mailing address

301 W FEE AVE STE 102
MELBOURNE FL
32901-4145
US

V. Phone/Fax

Practice location:
  • Phone: 321-479-2403
  • Fax:
Mailing address:
  • Phone: 321-479-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JERED WAYLAND
Title or Position: OWNER/MANAGING MEMBER
Credential: DC
Phone: 573-837-9107