Healthcare Provider Details

I. General information

NPI: 1760522700
Provider Name (Legal Business Name): BRYAN W. BELL ,CHIROPRACTOR, P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 US HIGHWAY 1 S SUITE B
ST AUGUSTINE FL
32086-6352
US

IV. Provider business mailing address

2820 US HIGHWAY 1 S SUITE B
ST AUGUSTINE FL
32086-6352
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-3232
  • Fax: 904-797-3234
Mailing address:
  • Phone: 904-797-3232
  • Fax: 904-797-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH0003959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: