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General NPI Number Information
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NPI Number | 1770354805
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Entity Type | Organization
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Legal Business Name | TOTAL CARE LONGEVITY CENTER, LLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 213 N FEDERAL HWY
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4342
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Country | US
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Telephone | 305-466-4357
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Fax | 305-466-4358
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Provider Business Mailing Address
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Address Line | 213 N FEDERAL HWY
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4342
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Country | US
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Telephone | 305-466-4357
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD A KERN
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Credential | DC
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Telephone | 305-466-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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