=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033365770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR DAVID BASS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2008
-----------------------------------------------------
Last Update Date | 08/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 N UNIVERSITY DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-475-4045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9737 NW 65TH PL
-----------------------------------------------------
City | PARKLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33076-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-649-6540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID B BASS
-----------------------------------------------------
Credential | DC, AP
-----------------------------------------------------
Telephone | 954-649-6540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | CH3178
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH3178
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------