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General NPI Number Information
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NPI Number | 1841518552
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Entity Type | Organization
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Legal Business Name | PARKSIDE CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 4319 20TH ST W SUITE 103
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City | BRADENTON
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State | FL
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Zip | 34205-5000
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Country | US
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Telephone | 941-752-4276
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Fax | 941-752-7201
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Provider Business Mailing Address
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Address Line | 4319 20TH ST W SUITE 103
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City | BRADENTON
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State | FL
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Zip | 34205-5000
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Country | US
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Telephone | 941-752-4276
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Fax | 941-752-7201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER TODD BRUGGER
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Credential | D.C.
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Telephone | 941-752-7246
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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 | CH8517
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License Number State | FL
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