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General NPI Number Information
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NPI Number | 1184907842
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Entity Type | Organization
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Legal Business Name | BREVARD SPINE CENTER LLC
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 878 N MIRAMAR AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-3054
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Country | US
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Telephone | 321-676-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 DUNCIL LN
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City | MALABAR
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State | FL
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Zip | 32950-3215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOSE ANDRES DEVESA
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Credential | D.C.
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Telephone | 352-538-9768
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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 | CH10213
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License Number State | FL
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