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General NPI Number Information
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NPI Number | 1023181773
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC INJURY AND RECOVERY CENTER INC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 4705 26TH ST W STE B
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City | BRADENTON
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State | FL
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Zip | 34207-1704
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Country | US
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Telephone | 941-755-1581
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Fax | 941-758-3577
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Provider Business Mailing Address
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Address Line | 4705 26TH ST W SUITE B
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City | BRADENTON
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State | FL
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Zip | 34207-1704
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Country | US
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Telephone | 941-755-1581
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. DEAN SCOTT SUTHERLAND
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Credential | DC
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Telephone | 941-755-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0006960
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License Number State | FL
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