Healthcare Provider Details

I. General information

NPI: 1366457137
Provider Name (Legal Business Name): SANDY BRAVAR CORRITORI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 P G A BLVD SUITE 104A
PALM BEACH GARDENS FL
33418-3900
US

IV. Provider business mailing address

5600 PGA BLVD SUITE 104A
PALM BEACH GARDENS FL
33418-3900
US

V. Phone/Fax

Practice location:
  • Phone: 561-632-6822
  • Fax: 561-624-4349
Mailing address:
  • Phone: 561-632-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: