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General NPI Number Information
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NPI Number | 1235872094
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Entity Type | Organization
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Legal Business Name | NEURO CIRCUIT CENTERS LLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 10650 W STATE ROAD 84 STE 208
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City | DAVIE
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State | FL
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Zip | 33324-4235
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Country | US
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Telephone | 954-410-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 W STATE ROAD 84 STE 208
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City | DAVIE
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State | FL
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Zip | 33324-4235
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Country | US
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Telephone | 954-410-2999
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Fax |
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Authorized Official
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Title or Position | PD
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Name | LISA HUSEBOE
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Credential |
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Telephone | 954-410-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number |
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License Number State |
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