=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023466141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN RELIEF CENTER OF HOMESTEAD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2016
-----------------------------------------------------
Last Update Date | 05/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 N HOMESTEAD BLVD
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-7416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-248-2250
-----------------------------------------------------
Fax | 305-248-2266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 N HOMESTEAD BLVD
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-7416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-248-2250
-----------------------------------------------------
Fax | 305-248-2266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRRESIDENT
-----------------------------------------------------
Name | DR. NEIL D BRESSLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 305-248-2250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------