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General NPI Number Information
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NPI Number | 1558271023
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Entity Type | Organization
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Legal Business Name | VICTORY SPINAL CARE BREVARD COUNTY LLC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 301 W FEE AVE STE 102
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City | MELBOURNE
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State | FL
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Zip | 32901-4145
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Country | US
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Telephone | 321-479-2403
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W FEE AVE STE 102
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City | MELBOURNE
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State | FL
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Zip | 32901-4145
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Country | US
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Telephone | 321-479-2403
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | JERED WAYLAND
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Credential | DC
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Telephone | 573-837-9107
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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 |
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License Number State |
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