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General NPI Number Information
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NPI Number | 1679873939
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Entity Type | Organization
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Legal Business Name | BRICKELL CHIROPRACTIC CENTER INC.
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 5975 N FEDERAL HWY 121
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-2690
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Country | US
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Telephone | 954-771-3800
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Fax | 954-351-0867
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Provider Business Mailing Address
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Address Line | 5975 NOTH FEDERAL HWY 121
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-2661
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Country | US
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Telephone | 954-771-3800
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Fax | 954-351-0867
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH SCOTT BRICKELL
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Credential | D.C.,DACBSP
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Telephone | 954-771-3800
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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 | 5087
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License Number State | FL
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