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General NPI Number Information
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NPI Number | 1659827962
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Entity Type | Organization
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Legal Business Name | FUSION CHIROPRACTIC HEALTH & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/27/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 680 E MAIN STREET SUITE 101
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City | BARTOW
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State | FL
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Zip | 33830-4803
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Country | US
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Telephone | 863-537-7330
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Fax | 863-582-9341
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Provider Business Mailing Address
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Address Line | 680 E MAIN STREET SUITE 101
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City | BARTOW
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State | FL
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Zip | 33830-4803
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Country | US
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Telephone | 863-537-7330
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Fax | 863-582-9341
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDI KALIA ANCRUM
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Credential | DC
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Telephone | 813-355-1600
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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 | CH11438
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License Number State | FL
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