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General NPI Number Information
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NPI Number | 1407299506
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Entity Type | Organization
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Legal Business Name | BRIGHTSTAR CHIROPRACTIC AND PROGRESSIVE REHAB, LLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 17501 N DALE MABRY HWY
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City | LUTZ
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State | FL
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Zip | 33548-4521
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Country | US
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Telephone | 610-574-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 17501 N DALE MABRY HWY
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City | LUTZ
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State | FL
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Zip | 33548-4521
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Country | US
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Telephone | 610-574-0975
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. SEV M KESSLER
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Credential | D.C.
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Telephone | 610-574-0975
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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 | CH10382
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License Number State | FL
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