=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053501494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORRES FAMILY CHIROPRACTIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2007
-----------------------------------------------------
Last Update Date | 09/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12317 SW 112TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-270-9520
-----------------------------------------------------
Fax | 305-270-9522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14967 SW 158TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33196-5711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-278-2244
-----------------------------------------------------
Fax | 305-270-9522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. BRYAN KEITH TORRES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 305-270-9520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH9041
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------