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General NPI Number Information
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NPI Number | 1164759874
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Entity Type | Individual
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Provider Name | RICHARD S BIRD DC
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Gender | Male
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 625 S RONALD REAGAN BLVD
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City | LONGWOOD
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State | FL
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Zip | 32750-5470
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Country | US
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Telephone | 407-260-8879
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Fax | 321-594-5809
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Provider Business Mailing Address
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Address Line | 4739 S CONWAY RD
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City | ORLANDO
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State | FL
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Zip | 32812-1259
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Country | US
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Telephone | 407-260-8879
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Fax | 321-594-5809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH5219
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License Number State | FL
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