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General NPI Number Information
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NPI Number | 1750821112
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Entity Type | Organization
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Legal Business Name | BIRD CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 1307 WHITE HORSE RD BUILDING B SUITE 200
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-783-6789
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Fax | 856-783-7199
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Provider Business Mailing Address
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Address Line | 1307 WHITE HORSE RD BUILDING B SUITE 200
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-783-6789
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Fax | 856-783-7199
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. BRANDON W BIRD
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Credential | DC
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Telephone | 856-783-6789
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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 | 38MC00606300
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License Number State | NJ
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