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General NPI Number Information
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NPI Number | 1821746702
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Entity Type | Organization
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Legal Business Name | SPACE COAST CHIROPRACTIC & ACUPUNCTURE
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 1051 PORT MALABAR BLVD NE STE 2
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City | PALM BAY
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State | FL
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Zip | 32905-5153
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Country | US
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Telephone | 321-307-7307
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Fax | 321-265-4211
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Provider Business Mailing Address
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Address Line | 1051 PORT MALABAR BLVD NE STE 2
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City | PALM BAY
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State | FL
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Zip | 32905-5153
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Country | US
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Telephone | 321-307-7307
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Fax | 321-265-4211
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRAD FARNEY
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Credential | DC
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Telephone | 321-307-7307
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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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